Pharmacy Cost Form

Integrating Community Pharmacists and Clinical Sites for Patient-Centered HIV Care

OMB: 0920-1019

IC ID: 216729

Information Collection (IC) Details

View Information Collection (IC)

Pharmacy Cost Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Revised Pharmacy Cost Form Att 13_Pharmacy Cost Form_OMB comments_KB_clean copy.docx No   Paper Only

Health Illness Prevention

 

20 0
   
State, Local, and Tribal Governments
 
   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 40 0 40 0 0 0
Annual IC Time Burden (Hours) 400 0 400 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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