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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Anesthesis
Removed
0
0
0
Form and Instruction
0917-0009-8
0917-0009-8, Anesthesia Privileges Request Form
Audiology
Removed
0
0
0
Form and Instruction
0917-0009-12
OMB No. 0917-0009-12, Audiology Privileges Request Form
Dental Privileges
Removed
0
0
0
Form and Instruction
0917-0009-9
0917-0009-9, Dental Privleges Request Form
Indian Health Service Medical Staff Credentials and Privileges Files
Removed
0
0
0
Form and Instruction
0917-0009-1
Application for Medical Staff Appointment and/or Privileges
Initial Application to Medical Staff with Signature Documents
New
1200
900
0
Form and Instruction
0917-0009
IHS Medical Staff - Initial Application
Medical Privileges Request Form
Removed
0
0
0
Form and Instruction
0917-0009-4
0917-0009-4, Medical Privileges Request Form
OB-GYN
Removed
0
0
0
Form and Instruction
0917-0009-5
0917-0009-5, OB-GYN Privileges Form
Pathology
Removed
0
0
0
Form and Instruction
0917-009-15
OMB No. 0917-0009-15, Pathology Privileges Request Form
Podiatry
Removed
0
0
0
Form and Instruction
0917-0009-13
OMB Form No. 0917-0009-14, Podiatric Privileges Request Form
Psychiatry
Removed
0
0
0
Form and Instruction
0917-0009-7
0917-0009-7, Psychiatric Privileges Request Form
Psychology
Removed
0
0
0
Form and Instruction
0917-0009-11
OMB 0917-0009-11, Psychology Privileges Request Form
Radiology
Removed
0
0
0
Form and Instruction
0917-0009-14
OMB No. 0917-0009-14, Radiolgy Privileges Request Form
Reaapointment Request
Removed
0
0
0
Form and Instruction
0917-0009-3
0917-0009-3, Reappointment Request Form
Reappointment Application
New
1500
500
0
Form and Instruction
0917-0009
IHS MEDICAL STAFF - REAPPOINTMENT APPLICATION
Reference Letter
Removed
0
0
0
Form and Instruction
0917-0009-2
0917-0009-2, References Form
Surgery
Removed
0
0
0
Form and Instruction
0917-0009-6
0917-0009-6, Surgical Privileges Request Form
Total burden requested under this ICR:
2700
1400
0
To view an IC, click on IC Title