Information Collection

Bureau of Primary Health Care Patient Survey

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Bureau of Primary Health Care Patient Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.