Information Collection

Hospital Staff

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0990-0344 Data Elements Hospital Staff	Form
Form 0990-0344 Data Elements Hospital Staff	Form
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

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-survey		No	No	Paper Only
Form	0990-0344	Yes	Yes	Paper Only
Form	0990-0344	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 %

table that charts list of burden
	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

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.

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