Information Collection

Clinicians Caring for WTCHP Members

IC 234102 under ICR 201911-0920-009 · OMB 0920-1252.

Documents and Forms

Document Name Document Type
Clinicians Caring for WTCHP Members Form and Instruction
Brief Demographic Survey Att G_Brief Demo Survey_2018-11-14.pdf Form and Instruction
Focus group guide WTCHP Att D_FG protocol_2019-11.22.19 for OMB_clean.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Clinicians Caring for WTCHP Members	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	Brief Demographic Survey	Att G_Brief Demo Survey_2018-11-14.pdf		No		Paper Only
Form and Instruction	none	Focus group guide	WTCHP Att D_FG protocol_2019-11.22.19 for OMB_clean.docx		No		Paper Only

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	1,514	1,514

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.