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PATIENT INTAKE FORM THANK YOU for scheduling your appointment with us! Name: ___Nickname: ___Address: ___ City, State, Zip Code: ___ For apartments, please include apartment number. Phone Numbers
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Information Collection Request (ICR) is a formal request for information from the public or entities, typically used by government agencies to collect data.
Individuals, businesses, organizations, or entities that are requested to provide specific information by a government agency are required to file an Information Collection Request (ICR).
To fill out an Information Collection Request (ICR), individuals or entities must follow the guidelines and instructions provided by the specific government agency requesting the information.
The purpose of an Information Collection Request (ICR) is to gather specific information needed by a government agency for various purposes such as research, regulation, or compliance.
The information required to be reported on an Information Collection Request (ICR) may vary depending on the specific request made by the government agency, but typically includes data, statistics, or other relevant information.
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