Information Collection

Sponsor and Payor Feedback for the Early Payor Feedback Program (CDRH)

IC 249376 under ICR 202206-0910-014 · OMB 0910-0360.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0360 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Payor and Sponsor Intro Scripts and Emails.docx	Other-Scripts and Emails
Payor and Sponsor Intro Scripts and Emails.docx	Other-Scripts and Emails
Survey Questions.docx	Other-Questionnaire
Survey Questions.docx	Other-Questionnaire
0360 OMB Approval Memo - Sponsor Payor Feedback 2021.docx OMB Approval Memo	IC Document
0360 OMB Approval Memo - Sponsor Payor Feedback 2021.docx OMB Approval Memo	IC Document

IC Title:

Sponsor and Payor Feedback for the Early Payor Feedback Program (CDRH)

Agency IC Tracking Number:

CDRH

IC Status: Unchanged

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
Other-Scripts and Emails			Payor and Sponsor Intro Scripts and Emails.docx		Yes	No	Printable Only
Other-Questionnaire			Survey Questions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 22

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	22	22
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Approval Memo	0360 OMB Approval Memo - Sponsor Payor Feedback 2021.docx	09/17/2021

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