Information Collection

Benchmark & Follow-Up Web Survey – HCP Audience

IC 247689 under ICR 202105-0925-001 · OMB 0925-0769.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0769 can be found here:

Documents and Forms

Document Name Document Type
Form 6 Benchmark & Follow-Up Web Survey – HCP Audience Form
6 Custom Web Survey with Consumer and Provider Paths Attachment 6 - Custom Web Survey with Consumer and Provider Paths 060221.docx Form
6 Custom Web Survey with Consumer and Provider Paths Attachment 6 - Custom Web Survey with Consumer and Provider Paths 061721.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Benchmark & Follow-Up Web Survey â HCP Audience	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	6	Custom Web Survey with Consumer and Provider Paths	Attachment 6 - Custom Web Survey with Consumer and Provider Paths 061721.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.