OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Survey of Patients' Perceptions of the Impact of Third Party Billing on Clinical Research Participation

IC 207221 under ICR 201401-0925-006 · OMB 0925-0458.

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

View Information Collection (IC)

Survey of Patients' Perceptions of the Impact of Third Party Billing on Clinical Research Participation
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Third Party Billing Survey 3rd Party Survey Questions OMB Submission.docx No No Paper Only

Health Health Care Services

 

4,000 0
   
Individuals or Households
 
   0 %

  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 4,000 0 4,000 0 0 0
Annual IC Time Burden (Hours) 1,000 0 1,000 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Mini Supporting Statement CC Third Party Billing Mini Supporting Statement CC Third Party Billing.docx 06/05/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.