OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Staff at Primary Care Practices

IC 192998 under ICR 201101-0990-001 · OMB 0990-0361.

Documents and Forms
Document Name
Document Type
Other-Script
Other-Screener
Other-info
Other-info
Other-info
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Staff at Primary Care Practices
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-info 0990-PatientPerspective_App F3 Patient Letter Spanish.doc No No Paper Only
Other-Script 0990-PatientPerspective_App H2 Patient Recruitment Script Spanish.doc No No Paper Only
Other-Screener 0990-PatientPerspective_App C Physician Practice Screener.doc No No Paper Only
Other-info 0990-PatientPerspective_App F4 Patient Survey Fact Sheet Spanish.doc No No Paper Only
Other-info 0990-PatientPerspective_App E2 Patient Survey Spanish.doc No No Paper Only

Health Public Health Monitoring

 

42 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 42 0 0 0 0 42
Annual IC Time Burden (Hours) 11 0 0 0 0 11
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Log sheet 0990-PatientPerspective_App I Patient recruitment log.doc 05/04/2010
0990-PatientPerspective_App D3 Medical practice Followup Letter 0990-PatientPerspective_App D3 Medical practice Followup Letter.doc 05/04/2010
0990-PatientPerspecive_App D2 Physician Practice Fact Sheet 0990-PatientPerspecive_App D2 Physician Practice Fact Sheet.doc 05/04/2010
0990-PatientPerspective_App D1 Physician Practice Advance Letter 0990-PatientPerspective_App D1 Physician Practice Advance Letter.doc 05/04/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.