Information Collection

Office-Based Physicians Eligible/Physician Induction Interview

IC 43612 under ICR 200905-0920-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
NAHMCS Questionnaire.doc Instruction
NAMCS Att. A 2009 EMR survey Draft.doc Revised Physician Induction Interview Form IC Document

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.