Physician/PCMH Leader Interview

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Patient-Centered Medical Home (PCMH) Items Demonstration Study.

Documents and Forms

Document Name Document Type
Form 3 Physician/PCMH Leader Interview Form and Instruction
3 Attachment C: Script for Physician/PCMH Leader Attachment C-SCRIPT-PhysicianPCMH Leader_11Jan2017_FINAL.doc Form and Instruction
4 Attachment G: Physician/PCMH Leader Interview Protocol Attachment G-Provider Interview Protocol_22Dec2016.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Physician/PCMH Leader Interview	Agency IC Tracking Number:

Is this a Common Form? No		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	3	Attachment C: Script for Physician/PCMH Leader	Attachment C-SCRIPT-PhysicianPCMH Leader_11Jan2017_FINAL.doc		No		Paper Only
Form and Instruction	4	Attachment G: Physician/PCMH Leader Interview Protocol	Attachment G-Provider Interview Protocol_22Dec2016.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 176	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	176	176
Annual IC Time Burden (Hours)	117	117
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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