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Benchmark & Follow-Up Web Survey – HCP Audience

IC 247689 under ICR 202111-0925-006 · OMB 0925-0769.

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Benchmark & Follow-Up Web Survey – HCP Audience
 
No Modified
 
Voluntary
 

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 Updated Attachment 6 - Custom Web Survey with Consumer and Provider Paths_clean 110821.docx Yes Yes Fillable Fileable

Health Health Care Services

 

300 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,500 0 0 0 0 1,500
Annual IC Time Burden (Hours) 375 0 0 0 0 375
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Federal COVID Response HCP Suppl Materials Federal COVID Response 0925-0769 - HCP Suppl Materials.pptx 11/23/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.