Information Collection

BEEA RSG/REG/AMG IA/NC Pre-Visit Show Card

IC 220896 under ICR 201604-0925-001 · OMB 0925-0406.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10 BEEA RSG/REG/AMG IA/NC Pre-Visit Show Card	Form and Instruction
10 Attachment 17-7 and 17-8 BEEA IA/NC Pre-Visit Prep Showc Attachment 17-7 and 17-8_BEEA_IA_NC_Pre-Visit Prep Showcards_RSG® Groups.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	10	Attachment 17-7 and 17-8 BEEA IA/NC Pre-Visit Prep Showcards	Attachment 17-7 and 17-8_BEEA_IA_NC_Pre-Visit Prep Showcards_RSG&REG Groups.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09-25-0200 Clinical, Basic and Population-based Research Studies

FR Citation: 67 FR 60776

Number of Respondents: 160

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms

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	160	160
Annual IC Time Burden (Hours)	13	13
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.