Information Collection

NCCAM Health Professional Portal

IC 194132 under ICR 200809-0925-003 · OMB 0925-0530.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0530 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NCCAM Health Professional Portal	Form and Instruction
1 Discussion Guide Discussion guide_NCCAM_final (3).doc	Form and Instruction
generic_clearance_form HCP focus group eval 080210.doc generic_clearance_form HCP focus group eval 080210	IC Document
cover memo HCP focus group eval 080210.doc cover memo HCP focus group eval 080210	IC Document

IC Title:

NCCAM Health Professional Portal

Agency IC Tracking Number:

IC Status: New

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 and Instruction	1	Discussion Guide	Discussion guide_NCCAM_final (3).doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 36

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	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	36	0	0	0	0	0
Annual IC Time Burden (Hours)	54	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
generic_clearance_form HCP focus group eval 080210	generic_clearance_form HCP focus group eval 080210.doc	08/02/2010
cover memo HCP focus group eval 080210	cover memo HCP focus group eval 080210.doc	08/02/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.