Information Collection

Hospital Staff

IC 190407 under ICR 201005-0990-003 · OMB 0990-0344.

Documents and Forms

Document Name Document Type
0990-Attachment 1 For HAVBED emergency submssion.doc Other-survey
0990-0344 Data Elements 0990-0344Attachment 1.doc Form
0990-0344 Data Elements 0990-0344Attachment 2.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Hospital Staff	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
Other-survey			0990-Attachment 1 For HAVBED emergency submssion.doc	No	No	Paper Only
Form	0990-0344	Data Elements	0990-0344Attachment 1.doc	Yes	Yes	Paper Only
Form	0990-0344	Data Elements	0990-0344Attachment 2.doc	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,000	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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	6,000	-170	6,170
Annual IC Time Burden (Hours)	6,000	-170	6,170
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.