Barriers to Care Survey

Cooperative Re-Engagement Controlled Trial (CoRECT)

OMB: 0920-1133

IC ID: 220449

Information Collection (IC) Details

View Information Collection (IC)

Barriers to Care Survey
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none MA Barriers to Care Survey Att 5_Mass Barriers to Care Survey.docx Yes Yes Fillable Fileable
Form and Instruction none CT Barriers to Care Survey Att 6_Conn Barriers to Care Survey.docx Yes Yes Fillable Fileable
Form and Instruction none Phila Barriers to Care Survey Att 7_Phil Barriers to Care Survey.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,200 0
   
Individuals or Households
 
   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 1,200 0 1,200 0 0 0
Annual IC Time Burden (Hours) 600 0 600 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.

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