Information Collection

Health Professionals Survey (Nursing)

IC 245650 under ICR 202102-0920-003 · OMB 0920-1129.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 092-1129 Health Professionals Survey (Nursing)	Form and Instruction
092-1129 Health Professionals Survey_Nursing B4 Health Professionals Survey_Nursing.docx	Form and Instruction
092-1129 Health Professionals Survey_Nursing B4 Health Professionals Survey_Nursing.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-1129

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 421

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	092-1129	Health Professionals Survey_Nursing	B4 Health Professionals Survey_Nursing.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 667

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	667	667
Annual IC Time Burden (Hours)	101	101
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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