Information Collection

CAHPS Clinician & Group Survey, Adult Primary Care Questionnaire

IC 189786 under ICR 200907-0935-001 · OMB 0935-0158.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form #1 CAHPS Clinician & Group Survey, Adult Primary Care Questionnaire	Form and Instruction
Form #1 4 Point Scale Questionnaire Attachment B1 Questionnaire with 4pt Scale 6-17-2009.doc	Form and Instruction
Form #2 6 Point Scale Questionnaire Attachment B2 Questionnaire with 6pt Scale 6-17-2009.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form?

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 and Instruction	Form #1	4 Point Scale Questionnaire	Attachment B1 Questionnaire with 4pt Scale 6-17-2009.doc		Yes	Yes	Fillable Fileable
Form and Instruction	Form #2	6 Point Scale Questionnaire	Attachment B2 Questionnaire with 6pt Scale 6-17-2009.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	7,200	7,200
Annual IC Time Burden (Hours)	2,400	2,400
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.