Intervention Trials- Patient Baseline Survey

Intervention Trials To Retain HIV-Positive Patients in Medical Care

OMB: 0915-0330

IC ID: 190433

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Intervention Trials- Patient Baseline 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 7 Patient Baseline Survey Tab 7 Baseline ACASI 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 1,800 0 1,800 0 0 0
Annual IC Time Burden (Hours) 900 0 900 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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