Information Collection

Attachment R: Web Survey of CDS Connect Users

IC 242380 under ICR 202006-0935-003 · OMB 0935-0256.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 15 Attachment R: Web Survey of CDS Connect Users	Form and Instruction
15 Attachment R: Web Survey of CDS Connect Users Attachment R - Web Survey of CDS Connect Users.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	15	Attachment R: Web Survey of CDS Connect Users	Attachment R - Web Survey of CDS Connect Users.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 453

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	453	453
Annual IC Time Burden (Hours)	77	77
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.