Information Collection

Surgeons Ethical Survey Form

IC 204876 under ICR 201401-0925-002 · OMB 0925-0691.

Documents and Forms

Document Name Document Type
Form 1 Surgeons Ethical Survey Form Form and Instruction
1 National Survey on Ethical Dlilemmas in Surgery Survey Surgeon Ethics 1-3-14.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Surgeons Ethical Survey Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	National Survey on Ethical Dlilemmas in Surgery	Survey Surgeon Ethics 1-3-14.doc		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 %

	Approved	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.