Information Collection

NIDDK Health Care Provider Satisfaction Survey

IC 264999 under ICR 202103-0925-003 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Survey NIDDK Health Care Provider Satisfaction Survey	Form
2024-01-26_Burden-Disclosure-Statement-Slide_OCHIN-HCP.pptx	Other-Burden Disclosure Statement
1 Survey 2024-02-12_OCHIN-HCP-Survey.pdf	Form
2024-02-16_Survey-Request-for-Approval_OCHIN-HCP_revised.docx Template	IC Document

IC Title:

NIDDK Health Care Provider Satisfaction Survey

Agency IC Tracking Number:

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
Other-Burden Disclosure Statement					Yes	Yes	Printable Only
Form	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15

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	60	60
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Template		03/07/2024

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

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