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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.