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Serious Medical Procedure (SMR) Form - Pediatric surgeons
Serious Medical Procedure (SMR) Request Form
OMB: 0970-0561
IC ID: 244593
OMB.report
HHS/ACF
OMB 0970-0561
ICR 202311-0970-006
IC 244593
( )
Documents and Forms
Document Name
Document Type
Form 1
Serious Medical Procedure (SMR) Form - Pediatric surgeons
Form
1 Serious Medical Procedure (SMR) Request Form
SMR Form_Clean.docx
Form
1 Serious Medical Procedure (SMR) Request Form
SMR Form_Clean.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Serious Medical Procedure (SMR) Form - Pediatric surgeons
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
1
Serious Medical Procedure (SMR) Request Form
SMR Form_Clean.docx
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
ORR Division of Children's Services Records
FR Citation:
81 FR 46682
Number of Respondents:
250
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
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
115
0
-80
0
0
195
Annual IC Time Burden (Hours)
20
0
-23
0
0
43
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.