Information Collection

Surgeons Ethical Survey Form

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 National Survey on Ethical Dlilemmas in Surgery 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:

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	1				No	No	Paper Only

Federal Enterprise Architecture Business Reference Module

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 %

table that charts list of burden
	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

table that charts IC Documents
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.

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