Information Collection

Primary Care Provider Reminder Letter

IC 191093 under ICR 200910-0920-010 · OMB 0920-0836.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0836 can be found here:

Documents and Forms

Document Name Document Type
Att 10_PCP Survey Reminder Letter 092309.doc Other-WORD

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Primary Care Provider Reminder Letter	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
Other-WORD			Att 10_PCP Survey Reminder Letter 092309.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	442	442

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.