Information Collection

Emergency Care First-Responders, Physicians, Other Health Care Providers

IC 191875 under ICR 201005-0925-005 · OMB 0925-0612.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0612 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
iPhone Splash Screen Shot.pdf	Other-Screen Shot
iPhone App About Screen.pdf	Other-screen shot
iPhone User Notice Screen Shot.pdf	Other-Screen Shot
iPhone Screen for Data Entry for Emergency Worker.pdf	Other-screen shot
iPhone Screen Shot with collected info for Reunification Website.pdf	Other-screen shot
iPhone Screen Shot Burden Statement.pdf iPhone Screen Shot Burden Statement	IC Document

IC Title:

Emergency Care First-Responders, Physicians, Other Health Care Providers

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screen Shot	iPhone Splash Screen Shot.pdf	Yes	Yes	Paper Only
Other-screen shot	iPhone App About Screen.pdf	Yes	Yes	Paper Only
Other-Screen Shot	iPhone User Notice Screen Shot.pdf	Yes	Yes	Paper Only
Other-screen shot	iPhone Screen for Data Entry for Emergency Worker.pdf	Yes	Yes	Paper Only
Other-screen shot	iPhone Screen Shot with collected info for Reunification Website.pdf	Yes	Yes	Paper Only

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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	Previously Approved
Annual Number of Responses for this IC	50,000	50,000
Annual IC Time Burden (Hours)	4,000	4,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
iPhone Screen Shot Burden Statement	iPhone Screen Shot Burden Statement.pdf	05/05/2010

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