Information Collection

2. Selected Survey (one of 5)

IC 7161 under ICR 200803-0920-003 · OMB 0920-0692.

Documents and Forms

Document Name Document Type
Form 1 2. Selected Survey (one of 5) Form
1 Pediatricians Appendix_C_pediatricians.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	2. Selected Survey (one of 5)	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: Modified

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	1	Pediatricians	Appendix_C_pediatricians.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 900	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	900	-3,100	4,000
Annual IC Time Burden (Hours)	375	-1,625	2,000
Annual IC Cost Burden (Dollars)	0	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.