Medical office information form

Pilot Test of the Proposed Value and Efficiency Surveys and Communicating About Value Checklist

OMB: 0935-0211

IC ID: 206679

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Medical office information form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #7 Medical Office Information Form Attachment I - Medical Office Information Form.docx Yes Yes Paper Only

Health Consumer Health and Safety

 

96 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 96 0 96 0 0 0
Annual IC Time Burden (Hours) 16 0 16 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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