Serious Medical Procedure (SMR) Form - Care provider program staff

Serious Medical Procedure (SMR) Request Form

OMB: 0970-0561

IC ID: 244594

Information Collection (IC) Details

View Information Collection (IC)

Serious Medical Procedure (SMR) Form - Care provider program staff
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Serious Medical Procedure (SMR) Request Form SMR Form_Clean.docx Yes Yes Fillable Fileable

Community and Social Services Social Services

ORR Division of Children's Services Records  81 FR 46682

250 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 115 0 -80 0 0 195
Annual IC Time Burden (Hours) 17 0 -14 0 0 31
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

© 2024 OMB.report | Privacy Policy