Information Collection

Adverse Events LBTI NSSAE - Physicians

IC 183193 under ICR 201110-0920-006 · OMB 0920-0773.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0773 can be found here:

Documents and Forms

Document Name Document Type
Attachment 6 Adverse Events LTBI NSSAE Physician.doc Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adverse Events LBTI NSSAE - Physicians	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR A Sec 241 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment 6 Adverse Events LTBI NSSAE Physician.doc		No	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	10	10
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.