Information Collection

Survey on Rural Community Wealth and Health Care Provision - health care provider respondents in full study

IC 202489 under ICR 201205-0536-002 · OMB 0536-0072.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0536-0072 can be found here:

Documents and Forms

Document Name Document Type
Annex F_Health care provider questionnaire_7-12.docx Other-Health Care Provider Questionn

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey on Rural Community Wealth and Health Care Provision - health care provider respondents in full study	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-Health Care Provider Questionnaire for full study			Annex F_Health care provider questionnaire_7-12.docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,120	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,120	1,120
Annual IC Time Burden (Hours)	653	653
Annual IC Cost Burden (Dollars)	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.