Physicians/Medical Secretaries

The Healthy Communities Study: How Communities Shape Children?s Health (NHLBI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0649 can be found here:

Documents and Forms

Document Name Document Type
Form 19 Physicians/Medical Secretaries Form and Instruction
19 Record Retrieval Protocol HCS_SSA_ATTACH 19_RECORD RETRIEVAL PROTOCOL_SEPTEMBER 2011 FINAL for OMB.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Physicians/Medical Secretaries	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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 and Instruction	19	Record Retrieval Protocol	HCS_SSA_ATTACH 19_RECORD RETRIEVAL PROTOCOL_SEPTEMBER 2011 FINAL for OMB.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,750	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,750	4,750
Annual IC Time Burden (Hours)	808	808
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.