OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Eisenberg Center Customer Satisfaction Survey for the Effective Health Care Program

IC 190004 under ICR 200702-0935-002 · OMB 0935-0128.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Eisenberg Center Customer Satisfaction Survey for the Effective Health Care Program
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #2 Consumer Summary Guides from health care providers - feedback questionnaire Attachment B2 -- Oral meds for Type 2 diabetes consumer guide _ feedback survey for health care providers.doc Yes Yes Fillable Fileable
Form and Instruction Form #3 Clinician and Policymaker Summary Guides from health care providers - feedback questionnaire Attachment B3 -- Oral meds for Type 2 diabetes clinician guide _ feedback survey for health care providers.doc Yes Yes Fillable Fileable
Form and Instruction Form #4 Clinician and Policymaker Summary Guides from policymakers & administrators - feedback questionnaire Attachment B4 -- Oral meds for Type 2 diabetes clinician guide _ feedback survey for policymakers _ administrators.doc Yes Yes Fillable Fileable
Form and Instruction Form #5 Osteoporosis Decision Aid - feedback questionnaire Attachment C1 -- Screen shots of the osteoporosis decision aid.doc Yes Yes Fillable Fileable
Form and Instruction Form #6 Glossary feedback questionnaire Attachment D -- Glossary feedback questionnaire.doc Yes Yes Fillable Fileable
Form and Instruction Form #7 Sample CME Followup Questionnaire Attachment E1 -- Sample CME Followup Questionnaire.doc Yes Yes Fillable Fileable
Form and Instruction Form #1 Consumer Summary Guides from people with the conditions - feedback questionnaire Attachment B1 -- Oral meds for Type 2 diabetes consumer guide _ feedback survey for people with type 2 diabetes.doc Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

1,320 0
   
Individuals or Households
 
   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 1,320 0 0 0 0 0
Annual IC Time Burden (Hours) 110 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement Part A EHC combined 7-1-09 Supporting Statement Part A EHC combined 7-1-09.doc 07/02/2009
Supporting Statement Part B EHC combined 5-29-09 Supporting Statement Part B EHC combined 5-29-09.doc 07/02/2009
Attachment C1 -- Screen shots of the osteoporosis decision aid Attachment C1 -- Screen shots of the osteoporosis decision aid.doc 07/02/2009
Terms of Clearance TERMS OF CLEARANCE.doc 09/29/2009
AHRQ 9-18-09 memo PASSBACK 9-18-09.doc 09/29/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.