Information Collection

Liver Ultrasound Pilot

IC 218863 under ICR 201511-0920-004 · OMB 0920-0950.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0950 can be found here:

Documents and Forms

Document Name Document Type
Liver Ultrasound Pilot Form
Liver Ultrasound Att A2 Liver Ultrasound Form 091715.docx Form
Att A1 Liver Ultrasound Descrip 102915.docx Liver Ultrasound Pilot Description IC Document
Att B Advance TA 091715.docx Advance TA IC Document
Att C EConsent 091715.docx Electronic Consent IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Liver Ultrasound Pilot	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	Liver Ultrasound	Att A2 Liver Ultrasound Form 091715.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0167 Health Resources Utilization Statistics	FR Citation: 49 FR 37693

Number of Respondents: 575	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	575	575
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Liver Ultrasound Pilot Description	Att A1 Liver Ultrasound Descrip 102915.docx	11/05/2015
Advance TA	Att B Advance TA 091715.docx	11/05/2015
Electronic Consent	Att C EConsent 091715.docx	11/05/2015

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