Patient Survey

Understanding Health System Approaches to Chronic Pain Management

OMB: 0920-1374

IC ID: 251282

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Patient Survey 0920-21IE
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920- Patient Survey Att. B Patient Survey.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

667 0
   
Individuals or Households
 
   100 %

  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 667 0 667 0 0 0
Annual IC Time Burden (Hours) 111 0 111 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att J1_Screenshots_Patient Survey Att. J.1 Patient Survey Screen Shot.pdf 01/26/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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