Information Collection

Emergency Medical Services and Recordkeeping and Notice Requirements

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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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:

table that charts list of 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 %

table that charts list of burden
	Approved	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

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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