Information Collection

Pediatricians Survey

IC 220410 under ICR 202102-0920-003 · OMB 0920-1129.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Pediatricians Survey	Form
Survey of Pediatricians S4 Survey of Pediatricians - Baseline and Follow Up.pdf	Form
Survey of Pediatricians S4 Survey of Pediatricians - Baseline and Follow Up.pdf	Form
I7 Survey of Pediatricians - Baseline and Follow Up.docx Survey of Pediatricians	IC Document
I7 Survey of Pediatricians - Baseline and Follow Up.docx Survey of Pediatricians	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	none	Survey of Pediatricians	S4 Survey of Pediatricians - Baseline and Follow Up.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 534

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-1,068	1,068
Annual IC Time Burden (Hours)	-178	178
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Survey of Pediatricians	I7 Survey of Pediatricians - Baseline and Follow Up.docx	03/02/2016

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