View Information Collection (IC)

View Information Collection (IC)

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 0917-0009-14 OMB No. 0917-0009-14, Radiolgy Privileges Request Form Radiology_privileges_request_form[2].doc No No Paper Only

Health Illness Prevention

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

8 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 8 0 0 0 0 8
Annual IC Time Burden (Hours) 3 0 0 0 0 3
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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