OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Medical Assessment Form - Reporting Time for Pediatricians, General

IC 217788 under ICR 202312-0970-002 · OMB 0970-0466.

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

View Information Collection (IC)

Medical Assessment Form - Reporting Time for Pediatricians, General
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Medical Assessment Form ORR Medical Assessment Form_0970-0466_Clean.docx Yes Yes Fillable Fileable

Community and Social Services Social Services

ORR Division of Children's Services Records  81 FR 46682

300 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 252,000 0 0 0 0 252,000
Annual IC Time Burden (Hours) 55,440 0 0 0 0 55,440
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment B - Medical Assessment Form Instructional Letter for Medical Providers Attachment B_Medical Assessment Form Instructional Letter for Medical Providers.docx 08/02/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.