Information Collection

Self-Query Survey

IC 207741 under ICR 202102-0915-002 · OMB 0915-0366.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Self-Query Survey	Form and Instruction
2 Self Query Respondents survey screenshots.pdf FORM Attachment 13 Self Query Respondents survey screenshots.pdf	Form and Instruction
2 Self Query Respondents survey screenshots.pdf FORM Attachment 13 Self Query Respondents survey screenshots.pdf	Form and Instruction
Attachment 11 Self query survey codebook 1-21.pdf Attachment 11 Self query survey codebook 1-21	IC Document
Attachment 11 Self query survey codebook 1-21.pdf Attachment 11 Self query survey codebook 1-21	IC Document
Attachment 16 Email self querier.docx Attachment 16 Email self querier	IC Document
Attachment 16 Email self querier.docx Attachment 16 Email self querier	IC Document
1 Welcome Page.docx 1 Welcome Page	IC Document
1 Welcome Page.docx 1 Welcome Page	IC Document
2 Demographics Intro.docx 2 Demographics Intro	IC Document
2 Demographics Intro.docx 2 Demographics Intro	IC Document
3 Individuals - Demographics.docx 3 Individuals - Demographics	IC Document
3 Individuals - Demographics.docx 3 Individuals - Demographics	IC Document
4 Individuals - Query intro.docx 4 Individuals - Query intro	IC Document
4 Individuals - Query intro.docx 4 Individuals - Query intro	IC Document
5 Individuals - Query experiences.docx 5 Individuals - Query experiences	IC Document
5 Individuals - Query experiences.docx 5 Individuals - Query experiences	IC Document
6 Individuals - Report intro.docx 6 Individuals - Report intro	IC Document
6 Individuals - Report intro.docx 6 Individuals - Report intro	IC Document
7 Individuals - Report experiences.docx 7 Individuals - Report experiences	IC Document
7 Individuals - Report experiences.docx 7 Individuals - Report experiences	IC Document
8 Individuals - Dispute intro.docx 8 Individuals - Dispute intro	IC Document
8 Individuals - Dispute intro.docx 8 Individuals - Dispute intro	IC Document
9 Individuals - Dispute experience .docx 9 Individuals - Dispute experience	IC Document
9 Individuals - Dispute experience .docx 9 Individuals - Dispute experience	IC Document
10 Individuals - Perceptions.docx 10 Individuals - Perceptions	IC Document
10 Individuals - Perceptions.docx 10 Individuals - Perceptions	IC Document
11 Individuals - Satisfaction with products and services.docx 11 Individuals - Satisfaction with products and services	IC Document
11 Individuals - Satisfaction with products and services.docx 11 Individuals - Satisfaction with products and services	IC Document
12 Organizations - Demographics.docx 12 Organizations - Demographics	IC Document
12 Organizations - Demographics.docx 12 Organizations - Demographics	IC Document
13 Organizations - Query intro.docx 13 Organizations - Query intro	IC Document
13 Organizations - Query intro.docx 13 Organizations - Query intro	IC Document
14 Organizations - Query experiences.docx 14 Organizations - Query experiences	IC Document
14 Organizations - Query experiences.docx 14 Organizations - Query experiences	IC Document
15 Organization - Report intro.docx 15 Organization - Report intro	IC Document
15 Organization - Report intro.docx 15 Organization - Report intro	IC Document
16 Organizations - Report experiences.docx 16 Organizations - Report experiences	IC Document
16 Organizations - Report experiences.docx 16 Organizations - Report experiences	IC Document
17 Organizations - Dispute intro.docx 17 Organizations - Dispute intro	IC Document
17 Organizations - Dispute intro.docx 17 Organizations - Dispute intro	IC Document
18 Organizations - Dispute experience.docx 18 Organizations - Dispute experience	IC Document
18 Organizations - Dispute experience.docx 18 Organizations - Dispute experience	IC Document
19 Organizations - Perceptions.docx 19 Organizations - Perceptions	IC Document
19 Organizations - Perceptions.docx 19 Organizations - Perceptions	IC Document
20 Organizations - Satisfaction with products and services.docx 20 Organizations - Satisfaction with products and services	IC Document
20 Organizations - Satisfaction with products and services.docx 20 Organizations - Satisfaction with products and services	IC Document
21 NPDB HIPDB Merger.docx 21 NPDB HIPDB Merger	IC Document
21 NPDB HIPDB Merger.docx 21 NPDB HIPDB Merger	IC Document
22 End comments.docx 22 End comments	IC Document
22 End comments.docx 22 End comments	IC Document
SelfQuery_Flowchart.pdf SelfQuery_Flowchart	IC Document
SelfQuery_Flowchart.pdf SelfQuery_Flowchart	IC Document
SelfQuery_Flowchart_June_2020.pdf SelfQuery_Flowchart_June_2020	IC Document
SelfQuery_Flowchart_June_2020.pdf SelfQuery_Flowchart_June_2020	IC Document

Information Collection (IC) Details

Record metadata
IC Title	Self-Query Survey