Patient Navigator Demonstration Program Evaluation - Patient Navigator Level

Patient Navigator Demonstration Program Evaluation

Documents and Forms

Document Name Document Type
Attachment A - HRSA PNDP Data Dictionary.pdf Other-Data Dictionary
001 - Patient Navi Patient Navigator Tracking Log Attachment B - Patient Tracking Log.pdf Form

Information Collection (IC) Details

IC Title:	Patient Navigator Demonstration Program Evaluation - Patient Navigator Level	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
Other-Data Dictionary			Attachment A - HRSA PNDP Data Dictionary.pdf		Yes	Yes	Fillable Fileable
Form	001 - Patient Navigator Tracking Log	Patient Navigator Tracking Log	Attachment B - Patient Tracking Log.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	22,530	22,530
Annual IC Time Burden (Hours)	5,633	5,633
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.