View Information Collection (IC)
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Surgery
 
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 0917-0009-6 0917-0009-6, Surgical Privileges Request Form Surgical_privileges_request_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

20 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 20 0 0 0 0 20
Annual IC Time Burden (Hours) 20 0 0 0 0 20
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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