Information Collection

Emergency Care First-Responders, Physicians, Other Health Care Providers

IC 191875 under ICR 201606-0925-007 · OMB 0925-0612.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Emergency Care First-Responders, Physicians, Other Health Care Providers	Form and Instruction
1 iPhone iPad Screenshots Attachment 2 Screenshot Information Ver 04-4-2013.pdf	Form and Instruction
Attachment 1_NLM People Locator_Data Elements.docx Attachment 1_NLM People Locator_Data Elements	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	1	iPhone iPad Screenshots	Attachment 2 Screenshot Information Ver 04-4-2013.pdf		Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-50,000	50,000
Annual IC Time Burden (Hours)	-2,500	2,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 1_NLM People Locator_Data Elements	Attachment 1_NLM People Locator_Data Elements.docx	07/08/2013

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