Information Collection

Medical Assistants Follow-up Survey

IC 220405 under ICR 202102-0920-003 · OMB 0920-1129.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Medical Assistants Follow-up Survey	Form
Medical Assistants Follow-up Survey P5 Medical Assistants Follow-up Survey.pdf	Form
Medical Assistants Follow-up Survey P5 Medical Assistants Follow-up Survey.pdf	Form
F5 Medical Assistants Follow Up Survey.docx Medical Assistants Follow-up Survey - word	IC Document
F5 Medical Assistants Follow Up Survey.docx Medical Assistants Follow-up Survey - word	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	none	Medical Assistants Follow-up Survey	P5 Medical Assistants Follow-up Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-200	200
Annual IC Time Burden (Hours)	-33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Medical Assistants Follow-up Survey - word	F5 Medical Assistants Follow Up Survey.docx	03/02/2016

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