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Survey of Office-based Physicians in Private Sector
Monitoring Changes in Attitudes and Practices among Family Planning Providers and Clinics
OMB: 0920-0969
IC ID: 203900
OMB.report
HHS/CDC
OMB 0920-0969
ICR 201810-0920-003
IC 203900
( )
Documents and Forms
Document Name
Document Type
Survey of Office-based Physicians in Private Sector
Form
Survey of Health Care Providers about Family Planning At
Att E-1 2018-2019 Survey of Health Care Providers about Family Planning.doc
Form
Survey of Health Care Providers about Family Planning At
Att E-2 Screen shots of provider survey.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Survey of Office-based Physicians in Private Sector
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
none
Survey of Health Care Providers about Family Planning Attitudes and Practices
Att E-1 2018-2019 Survey of Health Care Providers about Family Planning.doc
Yes
Yes
Fillable Fileable
Form
none
Survey of Health Care Providers about Family Planning Attitude and Practices - screenshots
Att E-2 Screen shots of provider survey.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,000
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
20 %
Approved
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
1,000
0
1,000
0
0
0
Annual IC Time Burden (Hours)
250
0
250
0
0
0
Annual IC Cost Burden (Dollars)
25,070
0
25,070
0
0
0
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.