Intervention Trials- Patient Exit Survey

Intervention Trials To Retain HIV-Positive Patients in Medical Care

OMB: 0915-0330

IC ID: 190431

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

View Information Collection (IC)

Intervention Trials- Patient Exit Survey
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Tab 4 Patient Exit Survey Tab 4 Patient Exit Survey.doc Yes No Printable Only

Health Health Care Services

 

1,800 0
   
Individuals or Households
 
   0 %

  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 3,600 0 3,600 0 0 0
Annual IC Time Burden (Hours) 119 0 119 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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