Information Collection

Survey of Healthcare Experiences of Patients (SHEP) -- Dental Care Patient Satisfaction Survey

IC 192326 under ICR 202108-2900-020 · OMB 2900-0764.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0764 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-10070 Survey of Healthcare Experiences of Patients (SHEP) -- Dental Care Patient Satisfaction Survey	Form and Instruction
10-10070 Dental Care Patient Satisfaction Survey (SHEP) Survey of Healthcare Experiences of Patients (SHEP) - Dental Care Patient Satisfaction Survey_ENG_2900-0764_2021.pdf	Form and Instruction
10-10070 Dental Care Patient Satisfaction Survey (SHEP) Survey of Healthcare Experiences of Patients (SHEP) - Dental Care Patient Satisfaction Survey_ENG_2900-0764_2021.pdf	Form and Instruction

IC Title:

Survey of Healthcare Experiences of Patients (SHEP) -- Dental Care Patient Satisfaction Survey

Agency IC Tracking Number:

2900-0764

Is this a Common Form? No

IC Status: Modified

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 and Instruction	10-10070	Dental Care Patient Satisfaction Survey (SHEP)	Survey of Healthcare Experiences of Patients (SHEP) - Dental Care Patient Satisfaction Survey_ENG_2900-0764_2021.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	50,400	13,815	36,585
Annual IC Time Burden (Hours)	12,600	3,454	9,146
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.