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A Survey of Physicians in Solo and Smaller Primary Care Practices
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form Form #1 Cognitive testing questionnaire Attachment A - Cognitive testing questionnaire.docx Yes Yes Paper Only
Form Form #2 Pilot survey questionnaire Attachment B - Pilot survey questionnaire.docx Yes Yes Paper Only
Form Form #3 Follow-up interview guide Attachment C - Follow up interview guide.docx Yes Yes Paper Only

Health Immunization Management

 

355 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 355 0 0 0 0 0
Annual IC Time Burden (Hours) 90 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment E - IH reminder postcard Attachment E - IH reminder postcard.docx 08/06/2012
Attachment D - IH Initial Contact Letter Attachment D - IH Initial Contact Letter.docx 08/06/2012
Attachment F - IH Follow-up Letter Attachment F - IH Follow-up Letter.docx 08/06/2012
SS Part B -- A Survey of Physicians in Solo Smaller PCPs 07 23 12 SS Part B -- A Survey of Physicians in Solo Smaller PCPs 07 23 12.docx 08/06/2012
SS Part A -- A Survey of Physicians in Solo Smaller PCPs 07 23 12 SS Part A -- A Survey of Physicians in Solo Smaller PCPs 07 23 12.docx 08/06/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.