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Federal forms, ICRs, and supporting documents

Information Collection

Destination of Released Patients Following Treatment with Iodine-131 and Estimation of Doses to Members of the Public at Locations Other Than Conventional Residences Receiving Such Patients

IC 218337 under ICR 201509-3150-004 · OMB 3150-0232.

Documents and Forms
Document Name
Document Type
Other-Survey
Other-Survey
Other-Survey
Other-Telephone Survey
Other-Telephone survey reminder
Information Collection (IC) Details

View Information Collection (IC)

Destination of Released Patients Following Treatment with Iodine-131 and Estimation of Doses to Members of the Public at Locations Other Than Conventional Residences Receiving Such Patients
 
No New
 
Voluntary
 
10 CFR 35

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Survey Treating institutions survey.pdf No   Paper Only
Other-Telephone survey reminder Survey Reminder Telephone Script for Patients.docx No   Paper Only
Other-Survey Hotel -Nursing Home Survey.docx No   Paper Only
Other-Telephone Survey Patient Telephone Interview Script.docx No   Paper Only
Other-Survey ThyCa Survey.docx Yes Yes Fillable Fileable

Energy Energy Resource Management

 

5,175 0
   
Private Sector Businesses or other for-profits
 
   90 %

  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 5,175 0 5,175 0 0 0
Annual IC Time Burden (Hours) 1,675 0 1,675 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.