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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 1 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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Surgeons Survey Instrument	Surgeons Survey.docx		No	No	Paper Only

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 %

	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

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.