Information Collection

Survey of Physician Practices in Laboratory Test Ordering and Interpretation

IC 197773 under ICR 201110-0920-009 · OMB 0920-0893.

Documents and Forms

Document Name Document Type
Survey of Physician Practices in Laboratory Test Ordering and Interpretation Form
Survey of Physician Practices CDC Questionnaire 10-17-2011.pdf Form
Attachment D Advance letter.doc Attachment D - Advance letter IC Document
Attachment E Email invite.docx Attachment E - Email invitation IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey of Physician Practices in Laboratory Test Ordering and Interpretation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Survey of Physician Practices	CDC Questionnaire 10-17-2011.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,600	Number of Respondents for Small Entity: 570

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,600	1,600
Annual IC Time Burden (Hours)	373	373
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment D - Advance letter	Attachment D Advance letter.doc	05/09/2011
Attachment E - Email invitation	Attachment E Email invite.docx	05/09/2011

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