OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Health Care Provider Verification Form

IC 183855 under ICR 200802-0920-009 · OMB 0920-0788.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Health Care Provider Verification Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction No number Attachment 5 - Healthcare Provider Verification Appendix 5a.2.Healthcare Provider Verification form.doc Yes No Paper Only

Health Illness Prevention

Epidemiologic Studies and Surveillance of Disease Problems  57 FR 62812

583 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 583 0 583 0 0 0
Annual IC Time Burden (Hours) 165 0 165 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 5a Attachment 5a.1.Provider recruitment letter.doc 12/19/2007
Attachment 5a Attachment 5a.3. Frequently Asked Questions by Healthcare Providers .doc 12/19/2007
Attachment 5b Provider website Frequently Asked Questions Attachment 5b Provider website Frequently Asked Questions.doc 12/19/2007
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.