Information Collection

Doctors, Students and Nurses

IC 189079 under ICR 201003-0925-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 1 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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Doctors, Students and Nurses	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
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
Form and Instruction	3	survey	Physician, Nurse, and Other, 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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	825	0	825
Annual IC Time Burden (Hours)	272	-141	413
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.