Patient Navigator Encounter/Target Services Log

Patient Navigator Outreach and Chronic Disease Prevention Demonstration Program

OMB: 0915-0346

IC ID: 198106

Information Collection (IC) Details

View Information Collection (IC)

Patient Navigator Encounter/Target Services Log
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 4 Forms_20110919.v1 Forms_20110919.v1.pdf Yes Yes Fillable Fileable
Form and Instruction 5 Target Services Log HRSA_Patient_Navigator_Demonstration_Program_Target_Form.doc Yes No Fillable Fileable

Health Health Care Services

 

46 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 28,962 0 28,962 0 0 0
Annual IC Time Burden (Hours) 7,241 0 7,241 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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