OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Interviews with Practice Manager and Physician Leader

IC 206887 under ICR 201305-0935-001 · OMB 0935-0212.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Interviews with Practice Manager and Physician Leader
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #4 Guide for Interview with Practice Manager Attachment D -- Guide for Interview with Practice Manager.docx Yes Yes Paper Only
Form and Instruction Form #4B Guide for Interview with Physician Leader Attachment E -- Guide for Interview with Physician Leader.docx Yes Yes Paper Only

Health Public Health Monitoring

 

12 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 12 0 12 0 0 0
Annual IC Time Burden (Hours) 12 0 12 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment O -- Information Sheet for Practice Managers Attachment O -- Information Sheet for Practice Managers.docx 05/07/2013
Attachment P -- Information Sheet for Clinicians Attachment P -- Information Sheet for Clinicians.docx 05/07/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.