View Information Collection (IC)

View Information Collection (IC)

Reaapointment Request
No Unchanged
Required to Obtain or Retain Benefits

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0917-0009-3 0917-0009-3, Reappointment Request Form Request_for_Reappointment_form[1].doc No No Paper Only

Health Public Health Monitoring

Report of Modified or Altered Systems Medical Staff Credentials and Privileges Record  71 FR 16320

190 0
Individuals or Households
   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 190 0 0 0 0 190
Annual IC Time Burden (Hours) 190 0 0 0 0 190
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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