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Federal forms, ICRs, and supporting documents

Information Collection

Anticoagulation Manager Mobile App User Feedback

IC 229982 under ICR 201606-0920-007 · OMB 0920-0974.

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

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Anticoagulation Manager Mobile App User Feedback 0920-0974-18OE
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Anticoagulation Manager Mobile App User Survey 04_ACM Survey Instrument screen shot 02-02-2018.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

2,000 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 2,000 0 2,000 0 0 0
Annual IC Time Burden (Hours) 167 0 167 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Request for Approval 01_Request for approval form CLIHC ACM 02-02-2018.docx 02/07/2018
Notification for App 03_Screen shot of push notification for ACM survey 02-02-2018.pdf 02/07/2018
Survey invitation 02_Screen shot of ACM Take User Survey page 02-02-2018.pdf 02/07/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.