OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Survey Respondents

IC 200924 under ICR 201106-0990-003 · OMB 0990-0376.

Documents and Forms
Document Name
Document Type
Other-survey
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Survey Respondents
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-survey 0990-0376_Survey for Developing Education for Sharing Patient Medical Info_eConsent_Survey_v1.docx No No Paper Only

Health Illness Prevention

 

2,800 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 2,800 0 0 0 0 0
Annual IC Time Burden (Hours) 233 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
0990-0376_Survey for Developing Education for Sharing Patient Medical Info_eConsent_cover_letter_v1 0990-0376_Survey for Developing Education for Sharing Patient Medical Info_eConsent_cover_letter_v1.docx 01/10/2012
mini supporting st 0990-0376_Mini Supporting Statement Cognitive Testing Consumer Privacy Security.docx 01/10/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.