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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Affiliation Verification
New
4225
1056
0
Form and Instruction
0917-0009
Affiliation Verification
Credentialing by Proxy Intake Form
New
250
63
0
Form and Instruction
0917-0009
Cred by Proxy
Education Verification
New
3289
822
0
Form and Instruction
0917-0009
Education Verification
Indian Health Service (IHS) Conditions of Application and Release
New
3840
320
0
Form and Instruction
0917-0009
Conditions of Application and Release
Indian Health Service Statement of Health
New
878
73
0
Form and Instruction
0917-0009
Statement of Health
Initial Application
New
878
878
0
Form and Instruction
0917-0009
Initial App
Initial Application to Medical Staff with Signature Documents
Removed
0
0
0
Form and Instruction
0917-0009
IHS Medical Staff - Initial Application
Malpractice Verification
New
2535
634
0
Form and Instruction
0917-0009
Malpractice Verification
Peer Reference Verification
New
6180
1545
0
Form and Instruction
0917-0009
Peer Reference Form
Pre-Application MD APP
New
500
250
0
Form and Instruction
0917-0009
Pre-Application MD App
Reappointment Application
New
2212
1106
0
Form and Instruction
0917-0009
Reappointment App
Reappointment Application
Removed
0
0
0
Form and Instruction
0917-0009
IHS MEDICAL STAFF - REAPPOINTMENT APPLICATION
Total burden requested under this ICR:
24787
6747
0
To view an IC, click on IC Title