Information Collection

State Surveys of Endoscopic Capacity

IC 193167 under ICR 201006-0920-003 · OMB 0920-0539.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0539_Att F1_SECAP II State Survey.doc	Other-WORD
0539_Att F3_State SECAP II Cover Letter.doc 0539_Att F3_State SECAP II Cover Letter	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			0539_Att F1_SECAP II State Survey.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 560

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	560	560
Annual IC Time Burden (Hours)	327	327
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0539_Att F3_State SECAP II Cover Letter	0539_Att F3_State SECAP II Cover Letter.doc	05/11/2010

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