CAHPS Clinician & Group Survey, Adult Primary Care Questionnaire

CAHPS Field Test of Proposed Health Information Technology Questions and Methodology

Documents and Forms

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

Information Collection (IC) Details

IC Title:	CAHPS Clinician & Group Survey, Adult Primary Care Questionnaire	Agency IC Tracking Number:

Is this a Common Form?		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 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 %

	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

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.