Patient Survey

Demonstration of Health Literacy Universal Precautions Toolkit

OMB: 0935-0202

IC ID: 202538

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 #6 Patient Survey Attachment I.1 -- Patient Survey.docx Yes Yes Fillable Fileable

Health Immunization Management

 

1,200 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 1,200 0 1,200 0 0 0
Annual IC Time Burden (Hours) 600 0 600 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment I Attachment I.2 -- Patient Survey Cover Memo-Tablet.docx 05/30/2012
Attachment I Attachment I.3 -- Patient Survey Cover memo-Paper.docx 05/30/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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