(EGAPP) - Health Care Providers (att D1)

Evaluation of Genomic Applications in Practice and Prevention (EGAPP)

Documents and Forms

Document Name Document Type
Form No number (EGAPP) - Health Care Providers (att D1) Form and Instruction
No number Healthcare provider survey Healthcare Provider Survey Revised 2-6-09.doc Form and Instruction

Information Collection (IC) Details

IC Title:	(EGAPP) - Health Care Providers (att D1)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	No number	Healthcare provider survey	Healthcare Provider Survey Revised 2-6-09.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,740	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,740	0	1,740
Annual IC Time Burden (Hours)	232	-58	290
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.