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
Credentialing by Proxy Intake Form New 250 63 0 Form and Instruction 0917-0009
Education Verification New 3289 822 0 Form and Instruction 0917-0009
Indian Health Service (IHS) Conditions of Application and Release New 3840 320 0 Form and Instruction 0917-0009
Initial Application New 878 878 0 Form and Instruction 0917-0009
Initial Application to Medical Staff with Signature Documents Removed 0 0 0 Form and Instruction 0917-0009
Malpractice Verification New 2535 634 0 Form and Instruction 0917-0009
Peer Reference Verification New 6180 1545 0 Form and Instruction 0917-0009
Pre-Application MD APP New 500 250 0 Form and Instruction 0917-0009
Reappointment Application New 2212 1106 0 Form and Instruction 0917-0009
Reappointment Application Removed 0 0 0 Form and Instruction 0917-0009
Total burden requested under this ICR: 23909 6674 0  
To view an IC, click on IC Title