View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Separately billing doctors questionnaire
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #9 Separately billing doctors questionnaire Attachment 92 -- MPC SBD Questionnaire.doc Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

12,450 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 24,900 0 24,900 0 0 0
Annual IC Time Burden (Hours) 1,245 0 1,245 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 93 -- MPC SBD Contact Guide Attachment 93 -- MPC SBD Contact Guide.doc 08/24/2009
Attachment 94 -- MPC SBD Cover Letter Attachment 94 -- MPC SBD Cover Letter.doc 08/24/2009
Attachment 95 -- MPC SBD FAQs Brochure Attachment 95 -- MPC SBD FAQs Brochure.doc 08/24/2009
Attachment 96 -- MPC SBD Fax Cover Sheet Attachment 96 -- MPC SBD Fax Cover Sheet.doc 08/24/2009
Attachment 97 -- MPC SBD Fax or Mail Return Form Attachment 97 -- MPC SBD Fax or Mail Return Form.doc 08/24/2009
Attachment 98 -- MPC SBD Instructions & Patient List - Phone Version Attachment 98 -- MPC SBD Instructions & Patient List - Phone Version.doc 08/24/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.