Information Collection

Evaluating Peer Notifications to Improve Statin Medication Adherence among Patients with Coronary Artery Disease

IC 212921 under ICR 201409-2900-006 · OMB 2900-0848.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-10139 Evaluating Peer Notifications to Improve Statin Medication Adherence among Patients with Coronary Artery Disease	Form and Instruction
10-10139 Evaluating Individual and Patient-Selected Family/Friend 10-10139 S5 VISN 4 Statin Medication Study Arm 1.pdf	Form and Instruction
10-10139a Evaluating Individual and Patient-Selected Family/Friend 10-10139a S5 VISN 4 Statin Medication Study Arm 2.pdf	Form and Instruction
10-10139b Evaluating Individual and Patient-Selected Family/Friend 10-10139b S5 VISN 4 Statin Medication Study Arm 3.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	10-10139	Evaluating Individual and Patient-Selected Family/Friend/or Reciprocal Peer Notifications to Improve Statin Medication Adherence among Patients with Coronary Artery Disease	10-10139 S5 VISN 4 Statin Medication Study Arm 1.pdf	No	Paper Only
Form and Instruction	10-10139a	Evaluating Individual and Patient-Selected Family/Friend/or Reciprocal Peer Notification to Improve Statin Medication Adherence among Patients with Coronary Artery Disease	10-10139a S5 VISN 4 Statin Medication Study Arm 2.pdf	No	Paper Only
Form and Instruction	10-10139b	Evaluating Individual and Patient-Selected Family/Friend/or Reciprocal Peer Notification to Improve Statin Medication Adherence among Patients with Coronary Artery Disease	10-10139b S5 VISN 4 Statin Medication Study Arm 3.pdf	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 224

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	224	224
Annual IC Time Burden (Hours)	784	784
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.