Information Collection

Division of Practitioner Data Bank (DPDB) Webinar Feedback and Satisfaction Surveys

IC 267569 under ICR 202503-0906-002 · OMB 0906-0084.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Division of Practitioner Data Bank (DPDB) Webinar Feedback and Satisfaction Surveys	Form
Form 1 Webinar Survey Questions Division of Practitioner Data Bank (DPDB) Webinar Feedback and Satisfaction Surveys	Form
1 Webinar Survey Questions Webinar Survey Questions for OMB ApprovalFinal.docx	Form
1 Webinar Survey Questions Webinar Survey Questions for OMB ApprovalFinal.docx	Form
Fast track Memo_Webinar QuestionsFinal.docx Fast Track Memo	IC Document
Fast track Memo_Webinar QuestionsFinal.docx Fast Track Memo	IC Document
Public Burden Statement.docx Public Burden Statement	IC Document
Public Burden Statement.docx Public Burden Statement	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

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
Form	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	2,400	2,400
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Memo		05/09/2024
Public Burden Statement		05/09/2024

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

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