View Information Collection (IC)

View Information Collection (IC)

Home care for health care providers questionnaire
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Attachment 78 Attachment 78 – MPC Home Care Provider Questionnaire for Health Care Providers Attachment 78 – MPC Home Care Provider Questionnaire for Health Care Providers.docx Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

635 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 972 0 0 0 0 972
Annual IC Time Burden (Hours) 146 0 0 0 0 146
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 76 – MPC Home Care Provider Authorization Form Package, Records to be Provided via Fax Anticipated Attachment 76 MPC HomeHealth_Fax_AF_Packet.doc 09/11/2015
Attachment 75 – MPC Home Care Provider Authorization Form Package, Phone Data Collection Anticipated Attachment 75 MPC HomeHealth_Phone_AF_Packet.doc 09/11/2015
Attachment 77 – MPC Home Care Provider Overflow Patient List Attachment 77 MPC HomeHealth_Overflow_Patient_List.docx 09/11/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.