Grantee PH Providers- Site Visit Interview

Primary and Behavioral Health Care Integration Program

OMB: 0930-0340

IC ID: 196131

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

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Grantee PH Providers- Site Visit Interview
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-survey 0990-0371Attach 3 SiteVisit_PC Providers.doc Yes Yes Fillable Fileable

Health Illness Prevention

 

40 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 -40 0 0 40
Annual IC Time Burden (Hours) 0 0 -60 0 0 60
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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