Survey of Office-based Physicians in the Private Sector

Evaluation of U.S. Family Planning Guidelines - Phase II

OMB: 0920-0969

IC ID: 203900

Information Collection (IC) Details

View Information Collection (IC)

Survey of Office-based Physicians in the Private Sector
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Survey of Health Care Providers D1_Provider Survey.doc Yes Yes Fillable Fileable

Health Immunization Management

 

2,000 0
   
Private Sector Businesses or other for-profits
 
   20 %

  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 2,000 0 2,000 0 0 0
Annual IC Time Burden (Hours) 500 0 500 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Provider Survey Cover Sheet D2_Provider Survey Cover Sheet.doc 08/22/2012
Initial Cover Letter C1_Private Sector Cover Letter.doc 08/22/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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