OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Providing Primary Care and Preventive Medical Services in Ryan White Funded Medical Care Settings

IC 218134 under ICR 201509-0906-001 · OMB 0906-0018.

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

View Information Collection (IC)

Providing Primary Care and Preventive Medical Services in Ryan White Funded Medical Care Settings
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Clinic Director Survey A_Clinic Director Survey.doc Yes Yes Fillable Fileable
Form and Instruction 2 Clinical Survey B_Clinician Survey.docx Yes Yes Fillable Fileable
Form and Instruction 3 Primary Care Data Extraction Template C_Primary Care Data Extraction Template.docx Yes Yes Fillable Fileable
Form and Instruction 4 Medical Director Interview Guide D_Medical Director Interview Guide.docx Yes No Printable Only

Health Health Care Services

 

280 0
   
State, Local, and Tribal Governments
 
   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 280 0 280 0 0 0
Annual IC Time Burden (Hours) 245 0 245 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.