Case Conference Form for Health Department

Cooperative Re-Engagement Controlled Trial (CoRECT)

OMB: 0920-1133

IC ID: 220454

Information Collection (IC) Details

View Information Collection (IC)

Case Conference Form for Health Department
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Case Conference for Health Dept Att 12a&b_Case Conference form.docx Yes Yes Fillable Fileable

Health Health Care Services

 

3 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 36 0 0 0 0 36
Annual IC Time Burden (Hours) 36 0 0 0 0 36
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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