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Federal forms, ICRs, and supporting documents

Information Collection

Clinic Staff Script - Approaching Clients

IC 200564 under ICR 201203-0920-006 · OMB 0920-0922.

Documents and Forms
Document Name
Document Type
Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Clinic Staff Script - Approaching Clients
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Rev Attachment 7d_Clinic Staff-Approaching Clients.doc Yes Yes Printable Only

Health Immunization Management

 

1,100 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,100 0 0 0 0 1,100
Annual IC Time Burden (Hours) 92 0 0 0 0 92
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attach 7a _Clinic Director Script Attach 7a _Clinic Director Script.doc 02/15/2012
Rev Attach 9b Clinic Survey Interviewer Script Rev Attach 9b Clinic Survey Interviewer Script.docx 02/15/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.