Information Collection

Assessment of Unreimbursed Care among Community Primary Care Physicians

IC 45710 under ICR 200610-0935-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
URC Paper survey_9-15-06.pdf	Other-Other
Unreiumbrsed Care Cover Letter to AAFP docs 10-05-06.doc Cover Letter	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.6

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Other			URC Paper survey_9-15-06.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 780

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	780	780
Annual IC Time Burden (Hours)	195	195
Annual IC Cost Burden (Dollars)	11,294	11,294

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Cover Letter	Unreiumbrsed Care Cover Letter to AAFP docs 10-05-06.doc	10/11/2006

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