Information Collection

Title IV Clinical Privileges Actions

IC 206486 under ICR 202310-0915-003 · OMB 0915-0126.

Documents and Forms

Document Name Document Type
Form 7 Title IV Clinical Privileges Actions Form and Instruction
7 Title IV Clinical Privileges Actions.pdf Title IV Clinical Privileges Actions.pdf Form and Instruction
7 Title IV Clinical Privileges Actions.pdf Title IV Clinical Privileges Actions.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Title IV Clinical Privileges Actions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	7	Title IV Clinical Privileges Actions.pdf	Title IV Clinical Privileges Actions.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: System of Record Notice 09-15-0054	FR Citation: 88 FR 17854

Number of Respondents: 782	Number of Respondents for Small Entity: 100

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	782	-196	978
Annual IC Time Burden (Hours)	587	-147	734
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.