Information Collection

Primary Care Clinician Survey

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Primary Care Clinician Survey	Agency IC Tracking Number:	0920-21IE

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

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	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 %

	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

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.