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Federal forms, ICRs, and supporting documents

Information Collection

Barriers to Care Assessment for WTC Health Program Care at Mt. Sinai

IC 232998 under ICR 201802-0920-007 · OMB 0920-0953.

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

View Information Collection (IC)

Barriers to Care Assessment for WTC Health Program Care at Mt. Sinai 0920-0953-18AZT
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none Member Questionnaire - English Barriers to care letter 090718.docx No   Paper Only
Form and Instruction none Member Questionnaire - Polish Barriers to care letter_POL.docx No   Paper Only
Form and Instruction none Member Questionnaire - Spanish Barriers to care letter_SPA.docx No   Paper Only

Health Health Care Services

 

3,600 0
   
Individuals or Households
 
   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 3,600 0 3,600 0 0 0
Annual IC Time Burden (Hours) 300 0 300 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Request for Approval Generic Clearance Submission Template - WTCHP MSSM Barriers to Care091318.docx 09/13/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.