Information Collection

Surgeons

IC 204876 under ICR 201211-0925-009 · OMB 0925-0691.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0691 can be found here:

2014-01-10 - New collection (Request for a new OMB Control Number)

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Surgeons Survey Instrument Surgeons	Form and Instruction
1 Surgeons Survey Instrument Surgeons Survey.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Surgeons

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 and Instruction	1				No	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-25-0156, "Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD

FR Citation: 60 FR 4238

Number of Respondents: 598

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	598	598
Annual IC Time Burden (Hours)	150	150
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.

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