OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Houston- Participant,Provider, Facility Administrator, Local Hub. Steering Committee Members

IC 203039 under ICR 201207-0990-005 · OMB 0990-0402.

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

View Information Collection (IC)

Houston- Participant,Provider, Facility Administrator, Local Hub. Steering Committee Members
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-survey Attachment_5A-0990-PatientCentered.docx No No Printable Only
Other-survey Attachment_5B-0990-PatientCentered.docx No No Printable Only
Other-survey Attachment_5C-0990-PatientCentered.docx No No Printable Only
Other-survey Attachment_5D (2)0990-PatientCentered.docx No No Printable Only
Other-survey Attachment_5E-0990-PatientCentered.docx No No Printable Only
Other-survey Attachment_5G-0990-PatientCentered.docx No No Printable Only
Other-survey Attachment_5F-0990-PatientCentered.docx No No Printable Only
Other-survey Attachment_5H-0990-PatientCentered.docx No No Printable Only
Other-survey Attachment_5I-0990-PatientCentered.docx No No Printable Only

Health Illness Prevention

 

1,125 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 1,125 0 1,125 0 0 0
Annual IC Time Burden (Hours) 555 0 555 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment_6A-0990-PatientCentered Attachment_6A-0990-PatientCentered.docx 07/03/2012
Attachment_8-0990-PatientCentered Attachment_8-0990-PatientCentered.docx 07/03/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.