After Visit Summary Survey

Clearance for A-11 Section 280 Improving Customer Experience Information Collection

OMB: 2900-0876

IC ID: 269404

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

After Visit Summary Survey 2900-0876 After Visit Summary Survey
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2900-0876 After Visit Summary 2900-0876 After Visit Summary Survey Wireframe Update AVS.docx Yes Yes Fillable Fileable

Health Health Care Services

 

50,000 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 50,000 0 0 0 0 50,000
Annual IC Time Burden (Hours) 2,500 0 0 0 0 2,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
After Visit Summary Survey ICR Template_A11 Section 280 AVS.pdf 07/12/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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