Screening Questionnaire

Patient Centered Care Collaboration to Improve Minority Health Project

OMB: 0990-0402

IC ID: 200846

Documents and Forms
Document Name
Document Type
Other-survey
Information Collection (IC) Details

View Information Collection (IC)

Screening Questionnaire
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-survey 0990-PCOR-Screening-ChicagoSurveys-Dec8-11.doc No No Printable Only

Health Illness Prevention

 

165 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 0 0 0 0 0 0
Annual IC Time Burden (Hours) 0 0 0 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.

© 2024 OMB.report | Privacy Policy