Chiropractic and Pharmacy Loan Repayment Program- Survey of Clinic Users

Chiropractic and Pharmacy Loan Repayment Program

Documents and Forms

Document Name Document Type
Form Clinic User Survey Chiropractic and Pharmacy Loan Repayment Program- Survey of Clinic Users Form and Instruction
Clinic User Survey Clinic User Survey- Pharmacist Tab B- Clinic User Survey-Pharmacy.doc Form and Instruction
Clinic User Survey Clinic User Survey- Chiro Tab B- Clinic User Survey-Chiropractic.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Chiropractic and Pharmacy Loan Repayment Program- Survey of Clinic Users	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	Clinic User Survey- Pharmacist	Clinic User Survey- Pharmacist	Tab B- Clinic User Survey-Pharmacy.doc		No	No	Paper Only
Form and Instruction	Clinic User Survey- Chiro	Clinic User Survey- Chiro	Tab B- Clinic User Survey-Chiropractic.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	500	500
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.