Registration Form

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Survey Comparative Database

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0197 can be found here:

Documents and Forms

Document Name Document Type
Form Form #1 Registration Form Form
Form #1 Clinician Group Submission System Registration Form Attachment A -- Clinician Group Submission System Registration Form 5-15-2012.docx Form

Information Collection (IC) Details

IC Title:	Registration Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Form #1	Clinician Group Submission System Registration Form	Attachment A -- Clinician Group Submission System Registration Form 5-15-2012.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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