Information Collection

EMS Professional Survey

IC 191676 under ICR 200912-0920-006 · OMB 0920-0844.

Documents and Forms

Document Name Document Type
AttachmentF_EMSProfessionalSurvey.doc Other-Survey
AttachmentI_Emails.doc E-Mail Reminder IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	EMS Professional Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-Survey			AttachmentF_EMSProfessionalSurvey.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
E-Mail Reminder	AttachmentI_Emails.doc	12/10/2009

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