(EGAPP) - Health Care Providers (att D1)

Evaluation of Genomic Applications in Practice and Prevention (EGAPP)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0751 can be found here:

Documents and Forms

Document Name Document Type
(EGAPP) - Health Care Providers (att D1) Form and Instruction
Health Care Provider Survey Attachment D1 Health Care Survey.doc Form and Instruction

Information Collection (IC) Details

IC Title:	(EGAPP) - Health Care Providers (att D1)	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	None	Health Care Provider Survey	Attachment D1 Health Care Survey.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,740	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,740	1,740
Annual IC Time Burden (Hours)	290	290
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.