OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Patients at Primary Care Practices

IC 192999 under ICR 201101-0990-001 · OMB 0990-0361.

Documents and Forms
Document Name
Document Type
Other-Script
Other-questionnaire
Other-letter
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Patients 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-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

Health Public Health Monitoring

 

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

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.