Information Collection

Office-Based Physicians Eligible/Physician Induction Interview

IC 43612 under ICR 200901-0920-007 · OMB 0920-0234.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0234 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NAHMCS Questionnaire.doc	Instruction
NAMCS Att. A 2009 EMR survey Draft.doc Revised Physician Induction Interview Form	IC Document

IC Title:

Office-Based Physicians Eligible/Physician Induction Interview

Agency IC Tracking Number:

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
Instruction			NAHMCS Questionnaire.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,164

Number of Respondents for Small Entity: 20

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,164	1,164
Annual IC Time Burden (Hours)	388	388
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Revised Physician Induction Interview Form	NAMCS Att. A 2009 EMR survey Draft.doc	01/14/2009

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