Information Collection

Mail survey with reminder card, mail and phone follow-up

IC 190199 under ICR 200908-0935-001 · OMB 0935-0157.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form #1 CAHPS Health Literacy Survey Instrument Mail survey with reminder card, mail and phone follow-up	Form and Instruction
Form #1 CAHPS Health Literacy Survey Instrument Attachment B -- CAHPS Health Literacy Survey Instrument.doc	Form and Instruction
Attachment C -- Pre-NotificationCoverLetters ReminderPCardLetterTelephone Script.doc Attachment C -- Pre-NotificationCoverLetters ReminderPCardLetterTelephone Script	IC Document

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 and Instruction	Form #1				Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

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	600	600
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment C -- Pre-NotificationCoverLetters ReminderPCardLetterTelephone Script		07/28/2009

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

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