Information Collection

Joes

IC 271546 under ICR 202410-0704-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
JOES-7 Questionnaire 10-3-2024.docx	Other-Survey
JOES-7 Questionnaire 10-3-2024.docx	Other-Survey
JOES-C Questionnaire_Revised_10.3.2024.docx	Other-Survey
JOES-C Questionnaire_Revised_10.3.2024.docx	Other-Survey
JOES-Ambulatory Survey_10.4.2024.docx	Other-Survey
JOES-Ambulatory Survey_10.4.2024.docx	Other-Survey
JOES-Dental Survey_10.4.2024.docx	Other-Survey
JOES-Dental Survey_10.4.2024.docx	Other-Survey
JOES-Emergency Department Survey_10.4.2024.docx	Other-Survey
JOES-Emergency Department Survey_10.4.2024.docx	Other-Survey
JOES-Walk-in Contraceptive Clinic Survey_10.4.2024.docx	Other-Survey
JOES-Walk-in Contraceptive Clinic Survey_10.4.2024.docx	Other-Survey

IC Title:

JOES

Agency IC Tracking Number:

0720-JOES

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	JOES-7 Questionnaire 10-3-2024.docx	Yes	Yes	Fillable Fileable
Other-Survey	JOES-C Questionnaire_Revised_10.3.2024.docx	Yes	Yes	Fillable Fileable
Other-Survey	JOES-Ambulatory Survey_10.4.2024.docx	Yes	Yes	Fillable Fileable
Other-Survey	JOES-Dental Survey_10.4.2024.docx	Yes	Yes	Fillable Fileable
Other-Survey	JOES-Emergency Department Survey_10.4.2024.docx	Yes	Yes	Fillable Fileable
Other-Survey	JOES-Walk-in Contraceptive Clinic Survey_10.4.2024.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Joint Outpatient Experience

FR Citation: 89 FR 56347

Number of Respondents: 310,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 70 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	310,000	310,000
Annual IC Time Burden (Hours)	26,533	26,533
Annual IC Cost Burden (Dollars)	834,250	834,250

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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