Student Survey

Assessing the Knowledge and Educational Needs of Students of Health Professions on Patient-Centered Outcomes Research

Documents and Forms

Document Name Document Type
Form Form #2 Student Survey Form and Instruction
Form #2 Student Survey Attachment A -- Student_Survey.docx Form and Instruction
Attachment B -- Invitation Email for Student Survey.docx Attachment B -- Invitation Email for Student Survey IC Document

Information Collection (IC) Details

IC Title:	Student Survey	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	Form #2	Student Survey	Attachment A -- Student_Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,800	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	1,800	1,800
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment B -- Invitation Email for Student Survey	Attachment B -- Invitation Email for Student Survey.docx	04/15/2013

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