Information Collection

Physicians

IC 208565 under ICR 201609-0925-002 · OMB 0925-0683.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Physicians	Form and Instruction
1 PRE AND POST SURVEYS Attachment 2_Pre and Post Surveys_Screenshots.pdf	Form and Instruction
Attachment 1_Pre and Post Surveys_Word Version.doc Attachment 1_Pre and Post Surveys_Word Version	IC Document

IC Title:

Physicians

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	PRE AND POST SURVEYS	Attachment 2_Pre and Post Surveys_Screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

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	-300	300
Annual IC Time Burden (Hours)	-100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 1_Pre and Post Surveys_Word Version	Attachment 1_Pre and Post Surveys_Word Version.doc	08/29/2013

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