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Federal forms, ICRs, and supporting documents

Information Collection

Survey on Rural Community Wealth and Health Care Provision - Mail/web survey with health care providers_respondents

IC 202481 under ICR 201508-0536-002 · OMB 0536-0072.

Documents and Forms
Document Name
Document Type
Other-Questionnaire
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Survey on Rural Community Wealth and Health Care Provision - Mail/web survey with health care providers_respondents
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Questionnaire Annex F_Health care provider questionnaire.docx Yes Yes Fillable Fileable

Health Health Care Services

 

558 0
   
Private Sector Businesses or other for-profits
 
   50 %

  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 558 0 0 0 0 558
Annual IC Time Burden (Hours) 297 0 0 0 0 297
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Report on Pilot Study of Health Care Providers Rural Community Survey Pilot Study Report_Providers Survey_2-5-2015.docx 02/13/2015
Script for Email Follow-up to Health Care Providers Provider Email Followup Script_2-9-15.docx 02/13/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.