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Federal forms, ICRs, and supporting documents

Information Collection

Intervention Trials- Retention Specialist/Patient Navigator Encounter Form

IC 190435 under ICR 200908-0915-003 · OMB 0915-0330.

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

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Intervention Trials- Retention Specialist/Patient Navigator Encounter Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Tab 9 RS/ PN Encounter Form Tab 9 Retention Spec-Patient Navigato Encounter Form.doc Yes No Printable Only

Health Health Care Services

 

12 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) 61 0 61 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.