Information Collection

Local EMS Provider Survey

IC 183635 under ICR 200801-0920-010 · OMB 0920-0782.

Documents and Forms

Document Name Document Type
Form No number Local EMS Provider Survey Form
No number Attachment D - Local EMS Provider Survey Att_D Local EMS Provider Survey.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Local EMS Provider 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	No number	Attachment D - Local EMS Provider Survey	Att_D Local EMS Provider Survey.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,800	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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)	450	450
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.