Pediatrician and Family Physicians Survey

Evaluation of the 2009 CHIPRA Quality Demonstration Grant Program: Survey Data Collection

OMB: 0935-0215

IC ID: 208374

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

View Information Collection (IC)

Pediatrician and Family Physicians 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 #1 Pediatrician and Family Physician Survey Attachment B - Pediatrician and Family Physician Survey.docx Yes Yes Paper Only

Health Immunization Management

 

1,200 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 1,200 0 1,200 0 0 0
Annual IC Time Burden (Hours) 300 0 300 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment D - CHIPRA_reminder postcard Attachment D - CHIPRA_reminder postcard.docx 08/22/2013
Attachment C -CHIPRA physician survey advance and cover letters Attachment C -CHIPRA physician survey advance and cover letters.docx 08/22/2013
Attachment E- CHIPRA physician survey reminder letter Attachment E- CHIPRA physician survey reminder letter.docx 08/22/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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