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Physician
Trends in U.S. Public's Awareness of Racial and Ethnic Heatlh Disparities (1999- 2008)
OMB: 0990-0335
IC ID: 186437
OMB.report
HHS/HHSDM
OMB 0990-0335
ICR 201203-0990-002
IC 186437
( )
Documents and Forms
Document Name
Document Type
0990-0335_Attachment J-4_followUpPhone.doc
Other-TELEPHONE SCRIPTS
0990-0335_Attachment M_Physician Booklet.doc
Other-QUESTIONNAIRE
0990-0335_Attachment J-1_PreNotLetter.doc
0990-0335_Attachment J-1_PreNotLetter
IC Document
0990-0335_Attachment J-2_CoverLetQuest.doc
0990-0335_Attachment J-2_CoverLetQuest
IC Document
0990-0335_Attachment J-3_followUpLet.doc
0990-0335_Attachment J-3_followUpLet
IC Document
0990-0335_Attachment K_FAQ.doc
0990-0335_Attachment K_FAQ
IC Document
0990-0335_Attachment N_Summary of Revisions.doc
0990-0335_Attachment N_Summary of Revisions
IC Document
0990-0335_Attachment L_PowerPrecision.doc
0990-0335_Attachment L_PowerPrecision
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Physician
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
Other-TELEPHONE SCRIPTS
0990-0335_Attachment J-4_followUpPhone.doc
No
No
Paper Only
Other-QUESTIONNAIRE
0990-0335_Attachment M_Physician Booklet.doc
No
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
340
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
340
0
0
-20
0
360
Annual IC Time Burden (Hours)
85
0
0
1
0
84
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
0990-0335_Attachment J-1_PreNotLetter
0990-0335_Attachment J-1_PreNotLetter.doc
03/28/2012
0990-0335_Attachment J-2_CoverLetQuest
0990-0335_Attachment J-2_CoverLetQuest.doc
03/28/2012
0990-0335_Attachment J-3_followUpLet
0990-0335_Attachment J-3_followUpLet.doc
03/28/2012
0990-0335_Attachment K_FAQ
0990-0335_Attachment K_FAQ.doc
03/28/2012
0990-0335_Attachment N_Summary of Revisions
0990-0335_Attachment N_Summary of Revisions.doc
03/28/2012
0990-0335_Attachment L_PowerPrecision
0990-0335_Attachment L_PowerPrecision.doc
03/28/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.