Information Collection

US Public Health Service (USPHS) Medical Officer Healthcare Access Survey

IC 225702 under ICR 201407-0920-003 · OMB 0920-1027.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
US Public Health Service (USPHS) Medical Officer Healthcare Access Survey	Form and Instruction
US PHS PPAC Survey on Access to Health Care Att 2_USPHS Data Collection Form.docx	Form and Instruction
FastTrack Template USPHS Survey.doc.docx FastTrack GenIC Request for Approval	IC Document
OnlineSurvey Service DeliveryChecklist.docx Service Delivery GenIC Checklist	IC Document

IC Title:

US Public Health Service (USPHS) Medical Officer Healthcare Access Survey

Agency IC Tracking Number:

17SJ

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	US PHS PPAC Survey on Access to Health Care	Att 2_USPHS Data Collection Form.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 790

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	790	790
Annual IC Time Burden (Hours)	132	132
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
FastTrack GenIC Request for Approval	FastTrack Template USPHS Survey.doc.docx	02/13/2017
Service Delivery GenIC Checklist	OnlineSurvey Service DeliveryChecklist.docx	02/13/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.