Information Collection

Sickle Cell Treatment Demonstration Medical Home Family Index

IC 185932 under ICR 200807-0915-003 · OMB 0915-0320.

Documents and Forms

Document Name Document Type
Form medical home index Sickle Cell Treatment Demonstration Medical Home Family Index Form
medical home index medical home index scell MHFamily Index .pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Sickle Cell Treatment Demonstration Medical Home Family Index	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	medical home index	medical home index	scell MHFamily Index .pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	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	800	800
Annual IC Time Burden (Hours)	200	200
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.