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Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - Medical Home Family Index

IC 197494 under ICR 201204-0915-001 · OMB 0915-0344.

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Form
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Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - Medical Home Family Index
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 007_Sickle Cell_Medical Home Index_Short 007_Sickle Cell_Medical Home Index_Short ATTACH_G_CMHI-MHI-Pediatric_Short-Version.pdf Yes Yes Fillable Fileable
Form 007_Sickle Cell_Medical Home Index_Full 007_Sickle Cell_Medical Home Index_Full ATTACH_F_CMHI-MHI-Pediatric_Full-Version.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

900 0
   
Individuals or Households
 
   100 %

  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 0 0 -1,800 0 0 1,800
Annual IC Time Burden (Hours) 0 0 -450 0 0 450
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.