Cognitive interviews for the Medical Office VE survey

Pilot Test of the Proposed Value and Efficiency Surveys and Communicating About Value Checklist

Documents and Forms

Document Name Document Type
Form Form #2 Cognitive interviews for the Medical Office VE survey Form and Instruction
Form #2 Cognitive Interview Guide for Medical Office VE Survey Attachment B - Cognitive Interview Guide for Medical Office VE Survey.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Cognitive interviews for the Medical Office VE survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form #2	Cognitive Interview Guide for Medical Office VE Survey	Attachment B - Cognitive Interview Guide for Medical Office VE Survey.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	9	9
Annual IC Time Burden (Hours)	14	14
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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