Information Collection

Patient Navigator Demonstration Program Evaluation - Grantee Level

IC 188564 under ICR 200903-0915-003 · OMB 0915-0328.

Documents and Forms

Document Name Document Type
Attachment A - HRSA PNDP Data Dictionary.pdf Other-Data Dictionary
003- Patient Navig Patient Navigator Grantee Quarterly Report Attachment C - QuarterlyReport.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Patient Navigator Demonstration Program Evaluation - Grantee Level	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	003- Patient Navigator Grantee Quarterly Report	Patient Navigator Grantee Quarterly Report	Attachment C - QuarterlyReport.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	12,060	12,060
Annual IC Time Burden (Hours)	12,060	12,060
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.