OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Patient survey

IC 196396 under ICR 201102-0935-002 · OMB 0935-0176.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Patient survey
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #11 Patient Survey Attachment Q -- Patient Survey 020411.doc Yes Yes Paper Only

Health Consumer Health and Safety

 

884 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 1,768 0 1,768 0 0 0
Annual IC Time Burden (Hours) 884 0 884 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment R -- Invitation to Participate in Patient Survey 020411 Attachment R -- Invitation to Participate in Patient Survey 020411.doc 02/10/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.