Information Collection

Community and Clinical Partner Program Implementation Partner Needs Assessment

IC 203972 under ICR 201309-0920-010 · OMB 0920-0952.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0952 can be found here:

Documents and Forms

Document Name Document Type
Community and Clinical Partner Program Implementation Partner Needs Assessment Form and Instruction
Att 5 Com and Clinical Partners Prog Implem Partner Need Att 5 Com and Clinical Partners Prog Implem Partner Needs Assmt.Revised.docx Form and Instruction
0920-0952 Attachment 5 (electronic) Attachment 5 (electronic).pdf Form and Instruction
Att 12. Clinical Component Best Practices.docx Att 12 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Community and Clinical Partner Program Implementation Partner Needs Assessment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Att 5 Com and Clinical Partners Prog Implem Partner Needs Assmt.Revised	Att 5 Com and Clinical Partners Prog Implem Partner Needs Assmt.Revised.docx		No	No	Paper Only
Form and Instruction	0920-0952	Attachment 5 (electronic)	Attachment 5 (electronic).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 12	Att 12. Clinical Component Best Practices.docx	09/04/2012

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