Information Collection

Clinical Support Tools Feedback Survey

IC 253194 under ICR 202203-0704-006 · OMB 0704-0553.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0553 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0704-0553_Clinical Support Tools Survey_11.02.21. V2.pdf	Other-Survey
One Pager_Clinical Support Tools Feedback Survey_4.18.22.docx One-Pager Clinical Support Tools Feedback Survey	IC Document

IC Title:

Clinical Support Tools Feedback Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			0704-0553_Clinical Support Tools Survey_11.02.21. V2.pdf		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	123	123

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
One-Pager Clinical Support Tools Feedback Survey	One Pager_Clinical Support Tools Feedback Survey_4.18.22.docx	05/03/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.