Information Collection

Outpatient Pharmacies

IC 206324 under ICR 201304-0920-001 · OMB 0920-0962.

Documents and Forms

Document Name Document Type
Appendix H Outpatient Prescription.docx Other-Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Outpatient Pharmacies	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Document			Appendix H Outpatient Prescription.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Occupational Health epidemiological Studies and EEOICPA Program Records and WTC Probram Records	FR Citation: 78 FR 31212

Number of Respondents: 4	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	1,060	1,060
Annual IC Time Burden (Hours)	18	18
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.