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Patient Advocate Pilot Questionnaire - Physician Interview

IC 122369 under ICR 199201-1215-001 · OMB 1215-0174.

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PATIENT ADVOCATE PILOT QUESTIONNAIRE - PHYSICIAN INTERVIEW
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form OWCP-54 No No


    

800 0
   
Private Sector Businesses or other for-profits
 
   0 %

  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 800 0 0 0 0 800
Annual IC Time Burden (Hours) 528 0 0 0 0 528
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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