Information Collection

Nurse Survey

IC 199796 under ICR 201110-0920-010 · OMB 0920-0914.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0914 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Nurse Survey	Form
Nurse Survey 10 7 2011 attachment-C4.docx	Form
Appendix F updated 9.30.11.docx Nurse Letter of Introduction	IC Document

IC Title:

Nurse Survey

Agency IC Tracking Number:

Is this a Common Form? No

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
Form	none	Nurse Survey	10 7 2011 attachment-C4.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	667	667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Nurse Letter of Introduction	Appendix F updated 9.30.11.docx	10/13/2011

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