Pharmacy Cost Form

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

OMB: 0920-1019

IC ID: 216729

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Pharmacy Cost Form
 
No Modified
 
Voluntary
 

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

Health Health Care Services

 

20 0
   
Private Sector Businesses or other for-profits
 
   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 0 0 0 40
Annual IC Time Burden (Hours) 400 0 0 0 0 400
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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