Patient Centered Medical Home (PCMH) Staff Satisfaction Survey

Documents and Forms

Document Name Document Type
PCMH SSS with Contractors - Screenshots.pdf Other-Survey
DHA Patient Centered Medical Home Survey invite.doc Other-Email Invite
Service PCMH Leads Memo.doc Other-Memo Reminder
DMDC-recommendation-letter-PCMH-Staff-Satisfaction-Survey-OMB-Dec-18-2013.pdf Other-DMDC Survey Review Memo

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Patient Centered Medical Home (PCMH) Staff Satisfaction Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	PCMH SSS with Contractors - Screenshots.pdf	Yes	Yes	Fillable Fileable
Other-Email Invite	DHA Patient Centered Medical Home Survey invite.doc	Yes	Yes	Fillable Fileable
Other-Memo Reminder	Service PCMH Leads Memo.doc	Yes	Yes	Fillable Fileable
Other-DMDC Survey Review Memo	DMDC-recommendation-letter-PCMH-Staff-Satisfaction-Survey-OMB-Dec-18-2013.pdf	Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,105	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,105	3,105
Annual IC Time Burden (Hours)	518	518
Annual IC Cost Burden (Dollars)	15,525	15,525

Documents for IC

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.