Information Collection

Physician

IC 186437 under ICR 201203-0990-002 · OMB 0990-0335.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0335_Attachment J-4_followUpPhone.doc	Other-TELEPHONE SCRIPTS
0990-0335_Attachment M_Physician Booklet.doc	Other-QUESTIONNAIRE
0990-0335_Attachment J-1_PreNotLetter.doc 0990-0335_Attachment J-1_PreNotLetter	IC Document
0990-0335_Attachment J-2_CoverLetQuest.doc 0990-0335_Attachment J-2_CoverLetQuest	IC Document
0990-0335_Attachment J-3_followUpLet.doc 0990-0335_Attachment J-3_followUpLet	IC Document
0990-0335_Attachment K_FAQ.doc 0990-0335_Attachment K_FAQ	IC Document
0990-0335_Attachment N_Summary of Revisions.doc 0990-0335_Attachment N_Summary of Revisions	IC Document
0990-0335_Attachment L_PowerPrecision.doc 0990-0335_Attachment L_PowerPrecision	IC Document

IC Title:

Physician

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
Other-TELEPHONE SCRIPTS			0990-0335_Attachment J-4_followUpPhone.doc		No	No	Paper Only
Other-QUESTIONNAIRE			0990-0335_Attachment M_Physician Booklet.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 340

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	340	-20	360
Annual IC Time Burden (Hours)	85	1	84
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0990-0335_Attachment J-1_PreNotLetter	0990-0335_Attachment J-1_PreNotLetter.doc	03/28/2012
0990-0335_Attachment J-2_CoverLetQuest	0990-0335_Attachment J-2_CoverLetQuest.doc	03/28/2012
0990-0335_Attachment J-3_followUpLet	0990-0335_Attachment J-3_followUpLet.doc	03/28/2012
0990-0335_Attachment K_FAQ	0990-0335_Attachment K_FAQ.doc	03/28/2012
0990-0335_Attachment N_Summary of Revisions	0990-0335_Attachment N_Summary of Revisions.doc	03/28/2012
0990-0335_Attachment L_PowerPrecision	0990-0335_Attachment L_PowerPrecision.doc	03/28/2012

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