OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Non Participant Components

IC 182193 under ICR 201406-0925-002 · OMB 0925-0584.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Non Participant Components
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Questionaire Physician Qx_English only.doc Yes Yes Fillable Fileable
Form and Instruction 2 Informant Interview Informant interview_English.doc Yes Yes Fillable Fileable

Health Health Care Services

 

1,284 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 0 0 -1,284 0 0 1,284
Annual IC Time Burden (Hours) 0 0 -642 0 0 642
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.