Patient Interview Guide

Assessing Problem Areas in Referrals for Chronic Hematologic Malignancies and Developing Interventions to Address Them

OMB: 0920-0836

IC ID: 191089

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Patient Interview Guide
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Att 6_Patient Interview Guide 092309.doc No No Fillable Printable

Health Health Care Services

09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems  57 FR 62812

18 0
   
Private Sector Businesses or other for-profits
 
   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 18 0 0 0 0 18
Annual IC Time Burden (Hours) 27 0 0 0 0 27
Annual IC Cost Burden (Dollars) 0 0 -492 0 0 492

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