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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.