View Information Collection (IC)

View Information Collection (IC)

IC Title:	Indian Health Service Medical Staff Credentials and Privileges Files	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

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	0917-0009-1	Application for Medical Staff Appointment and/or Privileges	IHS_Medi1 PDF.pdf	http://www.ihs.gov/RiskManagement/index.cfm?module=dsp_rm_resources	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: The Report of an Altered System of Records Medical Staff Credentials and Privileges Records	FR Citation: 74 FR 173

Number of Respondents: 570	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 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	570	0	0	0	0	570
Annual IC Time Burden (Hours)	570	0	0	0	0	570
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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