Information Collection

Report of Treatment by Attending Physician

IC 28333 under ICR 200803-2900-002 · OMB 2900-0120.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0120 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 29-551A Report of Treatment by Attending Physician	Form
29-551A Report of Treatment by Attending Physician fl29-551a(2-05).pdf	Form

IC Title:

Report of Treatment by Attending Physician

Agency IC Tracking Number:

2900-0120

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	29-551A	Report of Treatment by Attending Physician	fl29-551a(2-05).pdf		No		Paper Only

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,277

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	20,277	20,277
Annual IC Time Burden (Hours)	5,069	5,069
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.