Information Collection

National Survey of Medical Examiners

IC 208413 under ICR 201308-0920-011 · OMB 0920-0999.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 3_Questionnaire.docx	Other-WORD
Att 4b_Survey Cover Letter.docx Att 4b_Survey Cover Letter	IC Document
Att 4c_Reminder_Thank You Postcard.docx Att 4c_Reminder_Thank You Postcard	IC Document
Att 4d_Reminder Call.docx Att 4d_Reminder Call	IC Document

IC Title:

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
Other-WORD			Att 3_Questionnaire.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 576

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	576	576
Annual IC Time Burden (Hours)	288	288
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 4b_Survey Cover Letter	Att 4b_Survey Cover Letter.docx	08/27/2013
Att 4c_Reminder_Thank You Postcard	Att 4c_Reminder_Thank You Postcard.docx	08/27/2013
Att 4d_Reminder Call	Att 4d_Reminder Call.docx	08/27/2013

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