RETAIN Provider Surveys (R1 & R2)

Retaining Employment and Talent After Injury/Illness Network (RETAIN) demonstration

OMB: 0960-0821

IC ID: 246357

Documents and Forms
Document Name
Document Type
Other-RETAIN PROVIDER SURVEY INSTRUM
Other-RETAIN PROVIDER SURVEY INSTRUM
Other-RETAIN PROVIDER SURVEY MAILING
Other-RETAIN PROVIDER SURVEY MAILING
Information Collection (IC) Details

View Information Collection (IC)

RETAIN Provider Surveys (R1 & R2)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-RETAIN PROVIDER SURVEY INSTRUMENTS (R1, R2) APPENDIX G - PROVIDER SURVEY INSTRUMENTS (R1, R2).pdf No   Paper Only
Other-RETAIN PROVIDER SURVEY MAILINGS (R1, R2) APPENDIX H - PROVIDER SURVEY MAILINGS (R1, R2).pdf No   Paper Only

Income Security General Retirement and Disability

 

800 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 800 0 0 800 0 0
Annual IC Time Burden (Hours) 190 0 0 190 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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