Information Collection

Emergency Medical Services and Recordkeeping and Notice Requirements

IC 251895 under ICR 202410-1117-002 · OMB 1117-0060.

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Information Collection (IC) Details

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IC Title:	Emergency Medical Services and Recordkeeping and Notice Requirements	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 21 CFR 1304.03(i)and (j) 21 CFR 1304.04(a)(4) and (5) 21 CFR 1304.27

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21,283	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,106,716	1,106,716
Annual IC Time Burden (Hours)	92,226	92,226
Annual IC Cost Burden (Dollars)	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.