Information Collection

Bureau of Primary Health Care Patient Survey

IC 188365 under ICR 200903-0915-001 · OMB 0915-0326.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 001-BPHC Patient S Bureau of Primary Health Care Patient Survey	Form
001-BPHC Patient S BPHC Patient Survey Instrument Attachment 2 - Survey Instrument - 02-12-09.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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
Form	001-BPHC Patient Survey	BPHC Patient Survey Instrument	Attachment 2 - Survey Instrument - 02-12-09.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,773

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,773	5,773
Annual IC Time Burden (Hours)	7,218	7,218
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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