Information Collection

Radiation Exposure Screening and Education Program Measures

IC 217672 under ICR 201810-0906-003 · OMB 0906-0012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0012 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Radiation Exposure Screening and Education Program Measures	Form and Instruction
1 PIMS Measures PIMS Measures_RESEP Final DRAFT.docx	Form and Instruction
0906-0012 RESEP OMB Number and Expiration.jpg 0906-0012 RESEP OMB Number and Expiration	IC Document
0906-0012 RESEP Burden Statement.jpg 0906-0012 RESEP Burden Statement	IC Document

IC Title:

Radiation Exposure Screening and Education Program Measures

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	PIMS Measures	PIMS Measures_RESEP Final DRAFT.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8

Number of Respondents for Small Entity: 4

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	8	8
Annual IC Time Burden (Hours)	96	96
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0906-0012 RESEP OMB Number and Expiration	0906-0012 RESEP OMB Number and Expiration.jpg	10/24/2018
0906-0012 RESEP Burden Statement	0906-0012 RESEP Burden Statement.jpg	10/24/2018

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