Assessment of Unreimbursed Care among Community Primary Care Physicians

Documents and Forms

Document Name Document Type
Attachment 4 11-21-06.doc Other-Other
Unreimbursed Care Paper Survey 3-22-07.doc revised IC IC Document
AHRQ Response to OMB comments regarding URC 3-22-07.doc passback IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Assessment of Unreimbursed Care among Community Primary Care Physicians	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Other			Attachment 4 11-21-06.doc		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 %

	Approved	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)	0	0

Documents for IC

Title	Document	Date Uploaded
revised IC	Unreimbursed Care Paper Survey 3-22-07.doc	03/28/2007
passback	AHRQ Response to OMB comments regarding URC 3-22-07.doc	03/28/2007

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