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View Information Collection (IC)

View Information Collection (IC)

Attachment D – Patient Experience Survey_Data collection instrument
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2 No   Paper Only

Health Health Care Services

 

980 0
   
Individuals or Households
 
   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 980 0 -820 0 0 1,800
Annual IC Time Burden (Hours) 363 0 -303 0 0 666
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment C – Patient Experience Survey_Cover letter and reminder notice 07/28/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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