Information Collection

Screening for Self-Administered Surveys (Physician and other Health Professional)

IC 197809 under ICR 201105-0990-005 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-Attachment 2b ONC Communication Campaign Comments_MO-HITECH.pdf	Other-doc

IC Title:

Agency IC Tracking Number:

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-doc			0990-Attachment 2b ONC Communication Campaign Comments_MO-HITECH.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	8,000	0	0	0	0	0
Annual IC Time Burden (Hours)	1,333	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	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.