Information Collection

Survey of Physician Practices in Laboratory Test Ordering and Interpretation

IC 197773 under ICR 201110-0920-009 · OMB 0920-0893.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Survey of Physician Practices in Laboratory Test Ordering and Interpretation	Form
Survey of Physician Practices CDC Questionnaire 10-17-2011.pdf	Form
Attachment D Advance letter.doc Attachment D - Advance letter	IC Document
Attachment E Email invite.docx Attachment E - Email invitation	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form	none	Survey of Physician Practices	CDC Questionnaire 10-17-2011.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,600

Number of Respondents for Small Entity: 570

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,600	1,600
Annual IC Time Burden (Hours)	373	373
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment D - Advance letter	Attachment D Advance letter.doc	05/09/2011
Attachment E - Email invitation	Attachment E Email invite.docx	05/09/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.