Information Collection

Report of Treatment by Attending Physician

IC 28333 under ICR 201104-2900-007 · OMB 2900-0120.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0120 can be found here:

Documents and Forms

Document Name Document Type
Form 29-551A Report of Treatment by Attending Physician Form
29-551A Report of Treatment by Attending Physician fl29-551a(2-05).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Report of Treatment by Attending Physician	Agency IC Tracking Number:	2900-0120

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	29-551A	Report of Treatment by Attending Physician	fl29-551a(2-05).pdf		No		Paper Only

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,277	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	20,277	20,277
Annual IC Time Burden (Hours)	5,069	5,069
Annual IC Cost Burden (Dollars)	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.