Information Collection

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

IC 220904 under ICR 201604-0925-001 · OMB 0925-0406.

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	BEEA RSG/REG/AMG IA/NC Pre-Visit Show Card	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 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: 20	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Farms, 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	60	60
Annual IC Time Burden (Hours)	5	5
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.