OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Patient Pilot Study Surveys - Web based surveys

IC 208621 under ICR 201309-0915-001 · OMB 0915-0371.

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

View Information Collection (IC)

Patient Pilot Study Surveys - Web based surveys
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Pattient Baseline 4 AppendixF_BaselinePatientSurvey.docx Yes Yes Fillable Fileable
Form and Instruction 2 Patient Follow-up 4 AppendixG_FollowUpPatientSurvey.docx Yes Yes Fillable Fileable

Health Health Care Services

 

500 0
   
Individuals or Households
 
   100 %

  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 2,000 0 2,000 0 0 0
Annual IC Time Burden (Hours) 1,500 0 1,500 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.