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Federal forms, ICRs, and supporting documents

Information Collection

Medical Office Site Information Form

IC 201167 under ICR 202504-0935-001 · OMB 0935-0196.

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

View Information Collection (IC)

Medical Office Site Information Form
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #2 Medical Office Site Information Form Attachment C - Medical Office Site Information Form.docx Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

85 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 2,550 0 2,465 0 85 0
Annual IC Time Burden (Hours) 213 0 209 0 4 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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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