Information Collection

Benchmark & Follow-Up Web Survey – HCP Audience

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 6 Benchmark & Follow-Up Web Survey – HCP Audience	Form
6 Custom Web Survey with Consumer and Provider Paths Updated Attachment 6 - Custom Web Survey with Consumer and Provider Paths_clean 110821.docx	Form
6 Custom Web Survey with Consumer and Provider Paths Updated Attachment 6 - Custom Web Survey with Consumer and Provider Paths_clean 110821.docx	Form
Federal COVID Response 0925-0769 - HCP Suppl Materials.pptx Federal COVID Response HCP Suppl Materials	IC Document
Federal COVID Response 0925-0769 - HCP Suppl Materials.pptx Federal COVID Response HCP Suppl Materials	IC Document

IC Title:

Benchmark & Follow-Up Web Survey â HCP Audience

Agency IC Tracking Number:

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	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

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 %

table that charts list of burden
	Approved	Previously Approved
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

table that charts IC Documents
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.