Information Collection

Primary Care Associations (PCAs) Survey Tool Questions

IC 248938 under ICR 202108-0906-001 · OMB 0906-0062.

Documents and Forms

Document Name Document Type
Form 5 Primary Care Associations (PCAs) Survey Tool Questions Form and Instruction
5 PCAs Survey Tool Questions 7-21.pdf FORM 5 - PCAs Survey Tool Questions 7-21.pdf Form and Instruction
5 PCAs Survey Tool Questions 7-21.pdf FORM 5 - PCAs Survey Tool Questions 7-21.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Primary Care Associations (PCAs) Survey Tool Questions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	5	PCAs Survey Tool Questions 7-21.pdf	FORM 5 - PCAs Survey Tool Questions 7-21.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52	Number of Respondents for Small Entity: 52

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	312	312
Annual IC Time Burden (Hours)	234	234
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.