OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Ryan White HIV/AIDS Program Outcomes and Expanded Insurance Coverage Guides

IC 226197 under ICR 201703-0906-001 · OMB 0906-0030.

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

View Information Collection (IC)

Ryan White HIV/AIDS Program Outcomes and Expanded Insurance Coverage Guides
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Medical chart/record abstraction sample selection guide Medical chart abstraction guide.docx Yes Yes Fillable Fileable
Form and Instruction 2 Focus Groups Focus group guide .docx Yes Yes Fillable Fileable
Form and Instruction 3 Site interviews (site administrators) SIte interview guide .docx Yes Yes Fillable Fileable
Form and Instruction 4 Site Survey Site survey.docx Yes Yes Fillable Fileable

Health Health Care Services

 

440 20
   
Private Sector Businesses or other for-profits
 
   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 440 0 440 0 0 0
Annual IC Time Burden (Hours) 418 0 418 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.