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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Attachment 6 Adverse Events LTBI NSSAE Physician.doc	Instruction

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:

table that charts list of 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 %

table that charts list of burden
	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

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.