Information Collection

Assessment of Unreimbursed Care among Community Primary Care Physicians

IC 46414 under ICR 200612-0935-002 · OMB 0935-0129.

Documents and Forms

Documents and forms in this information collection
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

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			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 %

table that charts list of burden
	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

table that charts IC Documents
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.