OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Barriers to Care Survey

IC 220449 under ICR 201702-0920-002 · OMB 0920-1133.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Barriers to Care Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none MA Barriers to Care Survey Att 5_Mass Barriers to Care Survey.docx Yes Yes Fillable Fileable
Form and Instruction none CT Barriers to Care Survey Att 6_Conn Barriers to Care Survey.docx Yes Yes Fillable Fileable
Form and Instruction none Philadelphia Barriers to Care Survey (modified February 2017) Att7_PA Barr_to_care_02102017.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,200 0
   
Individuals or Households
 
   100 %

  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 1,200 0 0 0 0 1,200
Annual IC Time Burden (Hours) 600 0 0 0 0 600
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.