Information Collection

NP PA NOI Form

IC 224651 under ICR 201611-0930-002 · OMB 0930-0369.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0369 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NOI Form NP PA NOI Form	Form and Instruction
NOI Form NOI Form Qualifying Other Practitioner NOI 11.30.16.doc	Form and Instruction
CARA.pdf CARA	IC Document
Emergency FRN 11.28.16.pdf Published FRN	IC Document

IC Title:

NP PA NOI Form

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	NOI Form	NOI Form	Qualifying Other Practitioner NOI 11.30.16.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,406

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,406	1,406
Annual IC Time Burden (Hours)	93	93
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CARA	CARA.pdf	11/30/2016
Published FRN	Emergency FRN 11.28.16.pdf	11/30/2016

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