Information Collection

Portable X-ray Survey Report Form

IC 166063 under ICR 197803-0938-018 · OMB 0938-0027.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0027 can be found here:

Documents and Forms

Document Name Document Type

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Information Collection (IC) Details

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IC Title:	PORTABLE X-RAY SURVEY REPORT FORM	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-1882				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	150	30	120
Annual IC Time Burden (Hours)	750	150	600
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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