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Health Record
Safety and Health Information Collection
OMB: 0693-0080
IC ID: 231570
OMB.report
DOC/NIST
OMB 0693-0080
ICR 202408-0693-002
IC 231570
( )
Documents and Forms
Document Name
Document Type
Form NIST-986
Health Record
Form
NIST-986 Health Record
NIST-986 Health Record_2024FormsMngmt.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Health Record
Agency IC Tracking Number:
MO
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
NIST-986
Health Record
NIST-986 Health Record_2024FormsMngmt.pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
COMMERCE/DEPT-18: Employees Personnel Files Not Covered by Notices of Other Agencies
FR Citation:
72 FR 6200
Number of Respondents:
333
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
333
0
0
0
0
333
Annual IC Time Burden (Hours)
56
0
0
0
0
56
Annual IC Cost Burden (Dollars)
0
0
0
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.
