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Patient Pilot Study Screener - Intervention Screener

IC 208620 under ICR 201309-0915-001 · OMB 0915-0371.

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

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Patient Pilot Study Screener - Intervention Screener
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Survey Screener 3 AppendixE_SurveyScreener.doc Yes Yes Paper Only

Health Health Care Services

 

1,000 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 1,000 0 1,000 0 0 0
Annual IC Time Burden (Hours) 250 0 250 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
3 AppendixD_SurveyRecruitmentFlyer 3 AppendixD_SurveyRecruitmentFlyer.pub 08/30/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.