OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Assessment of Chronic Illness Care (ACIC)

IC 192653 under ICR 201004-0935-002 · OMB 0935-0166.

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

View Information Collection (IC)

Assessment of Chronic Illness Care (ACIC)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #6 Assessment of Chronic Illness Care (ACIC) Attachment G - Assessment of Chronic Illness Care (ACIC) Questionnaire.doc Yes Yes Paper Only

Health Consumer Health and Safety

 

10 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 240 0 240 0 0 0
Annual IC Time Burden (Hours) 120 0 120 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.