Information Collection

Physician - Cognitive Testing Protocol

IC 215714 under ICR 201503-0920-006 · OMB 0920-1063.

Documents and Forms

Document Name Document Type
Physician - Cognitive Testing Protocol Form
Cognitive Testing Protocol Att 4a - Cog Testing Protocol 022415.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Physician - Cognitive Testing Protocol	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	none	Cognitive Testing Protocol	Att 4a - Cog Testing Protocol 022415.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0167 Health Care Statistics	FR Citation: 49 FR 37697

Number of Respondents: 15	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	19	19
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.