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Attachment C – SelectMD 2.0 Clinician Choice Experiment Overview & Sample Wireframes

IC 211659 under ICR 201405-0935-007 · OMB 0935-0219.

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Attachment C – SelectMD 2.0 Clinician Choice Experiment Overview & Sample Wireframes
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2 SelectMD 2.0 Clinician Choice Experiment Overview & Sample Wireframes Attachment C_SelectMD 2.0 Clinician Choice Experiment Overview and Sample Wireframes.doc Yes Yes Fillable Fileable

Health Health Care Services

SelectMD 2.0 Clinician Choice Experiment Overview & Sample Wireframes  79 FR 4721

1,500 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 1,500 0 1,500 0 0 0
Annual IC Time Burden (Hours) 250 0 250 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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