PHC Labor Cost Questionnaire

Positive Health Check Evaluation Trial

OMB: 0920-1211

IC ID: 227361

Documents and Forms
Information Collection (IC) Details

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PHC Labor Cost Questionnaire
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA PHC Labor Cost Questionnaire - Att 13 Att 13 PHC cost questionnaire06.14.17.docx NA Yes Yes Fillable Fileable

Health Illness Prevention

 

4 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 4 0 4 0 0 0
Annual IC Time Burden (Hours) 6 0 6 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.

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