OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Patient Medical Record and Clini Data

IC 198108 under ICR 201206-0915-006 · OMB 0915-0346.

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

View Information Collection (IC)

Patient Medical Record and Clini Data
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 8 Clinical Measures HRSA_Patient_Navigator_Demonstration_Program_Clinical_Measures_Lab_Tests.doc Yes Yes Fillable Printable
Form and Instruction 7 Co-Occuring Disorders HRSA_Patient_Navigator_Demonstration_Program_Co_occurring_Disorders.doc Yes Yes Fillable Fileable

Health Health Care Services

 

10 0
   
Private Sector 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 4,827 0 0 0 0 4,827
Annual IC Time Burden (Hours) 821 0 0 0 0 821
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.