Post-Choice Test Questionnaire

SelectMD 2.0 Clinician Choice Experiment

OMB: 0935-0219

IC ID: 211660

Information Collection (IC) Details

View Information Collection (IC)

Post-Choice Test Questionnaire
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 3 Attachment D-2 – Post-Choice Test Questionnaire Attachment D-2_SelectMD 2.0 Post-Choice Questionnaire.docx Yes Yes Fillable Fileable

Health Health Care Services

Post-Choice Test Questionnaire  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) 500 0 500 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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