Information Collection

Doctors, Students and Nurses

IC 189079 under ICR 200905-0925-001 · OMB 0925-0602.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0602 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Doctors, Students and Nurses	Form and Instruction
1 survey Physician and Student Survey Questions.doc	Form and Instruction
2 survey Physician Survey Questions.doc	Form and Instruction
3 survey Physician, Nurse, and Other, Survey Questions.doc	Form and Instruction

IC Title:

Doctors, Students and Nurses

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3	survey	Physician, Nurse, and Other, Survey Questions.doc	Yes	Yes	Paper Only
Form and Instruction	1	survey	Physician and Student Survey Questions.doc	Yes	Yes	Paper Only
Form and Instruction	2	survey	Physician Survey Questions.doc	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 825

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	825	825
Annual IC Time Burden (Hours)	413	413
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.