Survey of NHSC Alumni (LRP)

Retention Survey of NHSC Clinicians and Alumni/NHSC Site Administrators

Documents and Forms

Document Name Document Type
Form 4 Survey of NHSC Alumni (LRP) Form
4 Survey of NHSC Alumni (LRP) RemoteAlumniClinician-Revised 6-30-11.pdf Form

Information Collection (IC) Details

IC Title:	Survey of NHSC Alumni (LRP)	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	4	Survey of NHSC Alumni (LRP)	RemoteAlumniClinician-Revised 6-30-11.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,393	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	2,393	2,393
Annual IC Time Burden (Hours)	550	550
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.