Information Collection

Patients at Primary Care Practices

IC 192999 under ICR 201005-0990-002 · OMB 0990-0361.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0361 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-PatientPerspective_App H2 Patient Recruitment Script Spanish.doc	Other-Script
0990-PatientPerspective_App E1 Patient Survey English.doc	Other-questionnaire
0990-PatientPerspective_App F2 Patient Survey Fact Sheet English.doc	Other-letter
0990-PatientPerspective_App G PracticeThank You letter.doc 0990-PatientPerspective_App G PracticeThank You letter	IC Document
0990-PatientPerspective_App F1 Patient Letter English.doc 0990-PatientPerspective_App F1 Patient Letter English	IC Document

IC Title:

Patients at Primary Care Practices

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Script	0990-PatientPerspective_App H2 Patient Recruitment Script Spanish.doc	No	No	Paper Only
Other-questionnaire	0990-PatientPerspective_App E1 Patient Survey English.doc	No	No	Paper Only
Other-letter	0990-PatientPerspective_App F2 Patient Survey Fact Sheet English.doc	No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 840

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	840	840
Annual IC Time Burden (Hours)	210	210
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0990-PatientPerspective_App G PracticeThank You letter	0990-PatientPerspective_App G PracticeThank You letter.doc	05/04/2010
0990-PatientPerspective_App F1 Patient Letter English	0990-PatientPerspective_App F1 Patient Letter English.doc	05/04/2010

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