Information Collection

CoE Patient

IC 178905 under ICR 200702-0990-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Round II CCOE Participant Survey_20061004.doc CoE Patient Survey	IC Document
Round_II_CCOE_Community_Partner_Survey_20061018.doc Community Control Survey	IC Document
Round II_CCOE_Site_Visit_Protocol_20061020.doc Site Visit Protocol	IC Document
Round_II_CCOE_CtrDirector_PC_Survey_20061020.doc Center Director PC Survey	IC Document
Round_II_CCOE_Eval_Meth_20061004 (2).doc Evaluation Meth	IC Document

IC Title:

CoE Patient

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.8

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,200	3,200
Annual IC Time Burden (Hours)	800	800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CoE Patient Survey	Round II CCOE Participant Survey_20061004.doc
Community Control Survey	Round_II_CCOE_Community_Partner_Survey_20061018.doc
Site Visit Protocol	Round II_CCOE_Site_Visit_Protocol_20061020.doc
Center Director PC Survey	Round_II_CCOE_CtrDirector_PC_Survey_20061020.doc
Evaluation Meth	Round_II_CCOE_Eval_Meth_20061004 (2).doc

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