Information Collection

Pretest for the Ambulatory Surgery SOPS

IC 208863 under ICR 201309-0935-001 · OMB 0935-0216.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form # 2 Pretest for the Ambulatory Surgery SOPS	Form and Instruction
Form # 2 Ambulatory Surgery SOPS Attachment B - Ambulatory Surgery SOPS.docx	Form and Instruction
Attachment D - Pretest Cover Letter and Reminder Notice for Survey.docx Attachment D - Pretest Cover Letter and Reminder Notice for Survey	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
Form and Instruction	Form # 2	Ambulatory Surgery SOPS	Attachment B - Ambulatory Surgery SOPS.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 529

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	529	529
Annual IC Time Burden (Hours)	132	132
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment D - Pretest Cover Letter and Reminder Notice for Survey	Attachment D - Pretest Cover Letter and Reminder Notice for Survey.docx	09/27/2013

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