Information Collection

Clinician - Clinician Survey

IC 272978 under ICR 202412-0920-006 · OMB 0920-1459.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1459 can be found here:

Documents and Forms

Document Name Document Type
Clinician - Clinician Survey Form and Instruction
Clinician Survey Attachment C_Clinician Survey_V10.docx Form and Instruction
Clinician Survey Attachment C_Clinician Survey_V10.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Clinician - Clinician Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Clinician Survey	Attachment C_Clinician Survey_V10.docx	N/A	No		Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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