OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Initial Application to Medical Staff with Signature Documents

IC 240117 under ICR 202307-0917-001 · OMB 0917-0009.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Initial Application to Medical Staff with Signature Documents
 
No Removed
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0917-0009 IHS Medical Staff - Initial Application Final - Initial Application OMB No 0917-0009 - 2020 - JW.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

1,200 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 0 0 0 -1,200 0 1,200
Annual IC Time Burden (Hours) 0 0 0 -900 0 900
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA OMB 0917-0009 Supporting Statement 2.27.20.docx 02/27/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.