Information Collection

Primary Care Clinician Survey

IC 251281 under ICR 202201-0920-014 · OMB 0920-1374.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920- Primary Care Clinician Survey	Form and Instruction
0920- Primary Care Clinician Survey Att. A Clinician Survey.docx	Form and Instruction
Att. J Clinician Survey Screen Shot.pdf Att J- Screenshots- Primary Care Clinician Survey	IC Document

IC Title:

Agency IC Tracking Number:

0920-21IE

Is this a Common Form? No

IC Status: New

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	0920-	Primary Care Clinician Survey	Att. A Clinician Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,313

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,313	1,313
Annual IC Time Burden (Hours)	219	219
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att J- Screenshots- Primary Care Clinician Survey	Att. J Clinician Survey Screen Shot.pdf	01/26/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.