Information Collection

National Ambulatory Medical Care Survey - 1980 Complement Survey

IC 112278 under ICR 197910-0937-001 · OMB 0937-0066.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	NATIONAL AMBULATORY MEDICAL CARE SURVEY - 1980 COMPLEMENT SURVEY	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	PHS-6105	No	No
Form	A, B, C,	No	No
Form	& D	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	17,000	17,000
Annual IC Time Burden (Hours)	617	617
Annual IC Cost Burden (Dollars)	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.