Health Care Providers and Suppliers

OMHA Annual Appellant Climate Survey

OMB: 0990-0330

IC ID: 184625

Information Collection (IC) Details

View Information Collection (IC)

Health Care Providers and Suppliers
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-survey Appendix B1 Appellant Climate Survey-Telephone (English).docx Yes Yes Fillable Fileable
Other-form Appendix B2 Appellant Climate Survey-Telephone (Spanish).docx No   Paper Only
Other-Survey Appendix B3 Appellant Climate Survey-Mail (English).docx No   Paper Only
Other-survey Appendix B4 Appellant Climate Survey-Mail (Spanish).docx No   Paper Only
Other-survey Appendix B5 Appellant Climate Survey-Web (English).docx Yes Yes Fillable Fileable
Other-survey Appendix B6 Appellant Climate Survey-Web (Spanish).docx Yes Yes Fillable Fileable

General Government Executive Functions

 

200 0
   
Individuals or Households
 
   0 %

  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 200 0 0 -40 0 240
Annual IC Time Burden (Hours) 50 0 0 6 0 44
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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