Patients at Primary Care Pactices (Patient Focus Groups)

Patient Perpective of Delivery of Health Care Through the use of an Electronic Health Record Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0361 can be found here:

Documents and Forms

Document Name Document Type
0990-PatientPerspective_App H2 Patient Recruitment Script Spanish.doc Other-Script
0990-PatientPerspective_App K Focus Group Moderator's Guide.doc Other-guide
0990-PatientPerspective_App H1 Patient Recruitment Script.doc Other-recruitment
0990-PatientPerspective_App J2 Focus Group Postcard.doc 0990-PatientPerspective_App J2 Focus Group Postcard IC Document
0990-PatientPerspective_App J1 Patient Focus Group Fact Sheet.doc 0990-PatientPerspective_App J1 Patient Focus Group Fact Sheet IC Document

Information Collection (IC) Details

IC Title:	Patients at Primary Care Pactices (Patient Focus Groups)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-recruitment	0990-PatientPerspective_App H1 Patient Recruitment Script.doc	No	No	Paper Only
Other-Script	0990-PatientPerspective_App H2 Patient Recruitment Script Spanish.doc	No	No	Paper Only
Other-guide	0990-PatientPerspective_App K Focus Group Moderator's Guide.doc	No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
0990-PatientPerspective_App J2 Focus Group Postcard	0990-PatientPerspective_App J2 Focus Group Postcard.doc	05/04/2010
0990-PatientPerspective_App J1 Patient Focus Group Fact Sheet	0990-PatientPerspective_App J1 Patient Focus Group Fact Sheet.doc	05/04/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.