Information Collection

Physician

IC 186437 under ICR 200809-0990-001 · OMB 0990-0335.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0335 can be found here:

2012-03-28 - Extension without change of a currently approved collection

Documents and Forms

Document Name Document Type
0990-Trends in the USAttachment F-2_Physician Questionnaire.docm Other-Questionnaire
0990-Trends in the USAttachment Q_Survey_Booklet.pdf Other-Survey
0990-Trends in the USAttachment A_PlanMeasure.docm 0990-Trends in the USAttachment A_PlanMeasure IC Document
0990-Trends in the USAttachment E-2_Crosswalk of Revisions_physician population.docm 0990-Trends in the USAttachment E-2_Crosswalk of Revisions_physician population IC Document
0990-Trends in the USAttachment H_PilotTestReport.docm 0990-Trends in the USAttachment H_PilotTestReport IC Document
0990-Trends in the USAttachment J_1999ItemsEXCLUDED.docm 0990-Trends in the USAttachment J_1999ItemsEXCLUDED IC Document
0990-Trends in USAttachment K_InterviewScripts.docm 0990-Trends in USAttachment K_InterviewScripts IC Document
0990-Trends in the USAttachment M-1_PreNotLetter.docm 0990-Trends in the USAttachment M-1_PreNotLetter IC Document
0990-Trends in the USAttachment M-2_CoverLetQuest.docm 0990-Trends in the USAttachment M-2_CoverLetQuest IC Document
0990-Trends in the USAttachment M-3_followUpLet.docm 0990-Trends in the USAttachment M-3_followUpLet IC Document
0990-Trends in the USAttachment M-4_followUpPhone.docm 0990-Trends in the USAttachment M-4_followUpPhone IC Document
0990-Trends in the USAttachment P-2 _NewItems_PhysicianPop.docm 0990-Trends in the USAttachment P-2 _NewItems_PhysicianPop IC Document
0990-Trends in the USAttachment R_Summary of Revisions.docm 0990-Trends in the USAttachment R_Summary of Revisions IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Physician	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
Other-Survey			0990-Trends in the USAttachment Q_Survey_Booklet.pdf		No	No	Paper Only
Other-Questionnaire			0990-Trends in the USAttachment F-2_Physician Questionnaire.docm		No	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 360	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	360	360
Annual IC Time Burden (Hours)	84	84
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
0990-Trends in the USAttachment A_PlanMeasure	0990-Trends in the USAttachment A_PlanMeasure.docm	08/08/2008
0990-Trends in the USAttachment E-2_Crosswalk of Revisions_physician population	0990-Trends in the USAttachment E-2_Crosswalk of Revisions_physician population.docm	08/08/2008
0990-Trends in the USAttachment H_PilotTestReport	0990-Trends in the USAttachment H_PilotTestReport.docm	08/08/2008
0990-Trends in the USAttachment J_1999ItemsEXCLUDED	0990-Trends in the USAttachment J_1999ItemsEXCLUDED.docm	08/08/2008
0990-Trends in USAttachment K_InterviewScripts	0990-Trends in USAttachment K_InterviewScripts.docm	08/08/2008
0990-Trends in the USAttachment M-1_PreNotLetter	0990-Trends in the USAttachment M-1_PreNotLetter.docm	08/08/2008
0990-Trends in the USAttachment M-2_CoverLetQuest	0990-Trends in the USAttachment M-2_CoverLetQuest.docm	08/08/2008
0990-Trends in the USAttachment M-3_followUpLet	0990-Trends in the USAttachment M-3_followUpLet.docm	08/08/2008
0990-Trends in the USAttachment M-4_followUpPhone	0990-Trends in the USAttachment M-4_followUpPhone.docm	08/08/2008
0990-Trends in the USAttachment P-2 _NewItems_PhysicianPop	0990-Trends in the USAttachment P-2 _NewItems_PhysicianPop.docm	08/08/2008
0990-Trends in the USAttachment R_Summary of Revisions	0990-Trends in the USAttachment R_Summary of Revisions.docm	08/08/2008

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