Survey for Health Professionals and Community Leaders (NIAAA)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Survey for Health Professionals and Community Leaders (NIAAA) Form and Instruction
1 Qualtrics Survey Screenshots HCP survey Qualtrics Survey Screenshots_hcp survey (2).docx Form and Instruction
NIAAA_OMB_Fast_Track_Form_hcp_survey_2.docx Fast track sub-study HCP survey IC Document
Appendix A email from partners .docx Appendix A email from Partners IC Document

Information Collection (IC) Details

IC Title:	Survey for Health Professionals and Community Leaders (NIAAA)	Agency IC Tracking Number:

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	1	Qualtrics Survey Screenshots HCP survey	Qualtrics Survey Screenshots_hcp survey (2).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast track sub-study HCP survey	NIAAA_OMB_Fast_Track_Form_hcp_survey_2.docx	06/24/2020
Appendix A email from Partners	Appendix A email from partners .docx	06/24/2020

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