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
Audiology Removed 0 0 0 Form and Instruction 0917-0009-12
Dental Privileges Removed 0 0 0 Form and Instruction 0917-0009-9
Indian Health Service Medical Staff Credentials and Privileges Files Removed 0 0 0 Form and Instruction 0917-0009-1
Initial Application to Medical Staff with Signature Documents New 1200 900 0 Form and Instruction 0917-0009
Medical Privileges Request Form Removed 0 0 0 Form and Instruction 0917-0009-4
OB-GYN Removed 0 0 0 Form and Instruction 0917-0009-5
Pathology Removed 0 0 0 Form and Instruction 0917-009-15
Podiatry Removed 0 0 0 Form and Instruction 0917-0009-13
Psychiatry Removed 0 0 0 Form and Instruction 0917-0009-7
Psychology Removed 0 0 0 Form and Instruction 0917-0009-11
Radiology Removed 0 0 0 Form and Instruction 0917-0009-14
Reaapointment Request Removed 0 0 0 Form and Instruction 0917-0009-3
Reappointment Application New 1500 500 0 Form and Instruction 0917-0009
Reference Letter Removed 0 0 0 Form and Instruction 0917-0009-2
Surgery Removed 0 0 0 Form and Instruction 0917-0009-6
Total burden requested under this ICR: 2700 1400 0  
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