Information Collection

Community and Clinical Partner Clinical Partner Needs Assessment

IC 203971 under ICR 201409-0920-009 · OMB 0920-0952.

Documents and Forms

Document Name Document Type
Community and Clinical Partner Clinical Partner Needs Assessment Form and Instruction
Clinical Partners Needs Assessment Attachment 4 (electronic v2).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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

Is this a Common Form? No		IC Status: Unchanged

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	none	Clinical Partners Needs Assessment	Attachment 4 (electronic v2).pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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	50	50
Annual IC Time Burden (Hours)	50	50
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.