Physician/Office Staff

Women's Health Initiative Observational Study (NHLBI)

Documents and Forms

Document Name Document Type
Form 120 Physician/Office Staff Form and Instruction
120 Initial Notification of Death F120V8.1.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Physician/Office Staff	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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 and Instruction	120	Initial Notification of Death	F120V8.1.pdf		No	No	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 17	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-17	17
Annual IC Time Burden (Hours)	-1	1
Annual IC Cost Burden (Dollars)	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.