Patients Standard Interview

Medical Monitoring Project

OMB: 0920-0740

IC ID: 178497

Information Collection (IC) Details

View Information Collection (IC)

Patients Standard Interview
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Standard Interview MMP 2013 Interview v.9.5.0_Clean.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

7,219 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 7,219 0 0 0 0 7,219
Annual IC Time Burden (Hours) 5,414 0 0 0 0 5,414
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Provider/Patient Model Scripts Attachment11_Model Scripts.doc 03/12/2009
Redlined version of Standard Interview MMP 2013 Interview v.9.5.0_Redlined.docx 01/30/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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