Information Collection

Medical Office SOPS Data Submission Emails

IC 201169 under ICR 202504-0935-001 · OMB 0935-0196.

Documents and Forms

Document Name Document Type
Form Form #4 Medical Office SOPS Data Submission Emails Form and Instruction
Form Form #4 Medical Office Data Submission Emails Medical Office SOPS Data Submission Emails Form and Instruction
Form #4 Medical Office Data Submission Emails Attachment D - Medical Office Data Submission Emails.docx Form and Instruction
Form #4 Medical Office Data Submission Emails Attachment D - Medical Office Data Submission Emails.docx Form and Instruction
Attachment F - SOPS Databases TEP List.docx Attachment F: Databases TEP List IC Document
Attachment F - SOPS Databases TEP List.docx Attachment F: Databases TEP List IC Document
Attachment D - Medical Office Data Submission Emails.docx Attachment D: Data Submission Emails IC Document
Attachment D - Medical Office Data Submission Emails.docx Attachment D: Data Submission Emails IC Document
Attachment G - Example Screenshots of MO SOPS Data Submission Website Information Collection.docx Attachment G: Example Screen Shots of Medical Office Survey on Patient Safety Culture Data Submission Web Site Information Colle IC Document
Attachment G - Example Screenshots of MO SOPS Data Submission Website Information Collection.docx Attachment G: Example Screen Shots of Medical Office Survey on Patient Safety Culture Data Submission Web Site Information Colle IC Document
60 Day FRN.pdf Federal Register Notice IC Document
60 Day FRN.pdf Federal Register Notice IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medical Office SOPS Data Submission Emails	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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 and Instruction	Form #4	Medical Office Data Submission Emails	Attachment D - Medical Office Data Submission Emails.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 85	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	85	85
Annual IC Time Burden (Hours)	85	85
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment F: Databases TEP List	Attachment F - SOPS Databases TEP List.docx	08/25/2021
Attachment D: Data Submission Emails	Attachment D - Medical Office Data Submission Emails.docx	08/25/2021
Attachment G: Example Screen Shots of Medical Office Survey on Patient Safety Culture Data Submission Web Site Information Collection	Attachment G - Example Screenshots of MO SOPS Data Submission Website Information Collection.docx	08/25/2021
Federal Register Notice	60 Day FRN.pdf	08/25/2021

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

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