PositiveLinks Verbal Consent and Enrollment

Using Real-time Prescription and Insurance Claims Data to Support the HIV Care Continuum

OMB: 0920-1361

IC ID: 249772

Information Collection (IC) Details

View Information Collection (IC)

PositiveLinks Verbal Consent and Enrollment
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a PositiveLinks Verbal Consent and Enrollment Att 12a_PositiveLinks verbal consent and enrollment.docx Yes Yes Fillable Fileable

Health Illness Prevention

Epidemiologic Studies and Surveillance of Disease Problems:(SORN) 09-20-0136  57 FR 62812

33 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 33 0 33 0 0 0
Annual IC Time Burden (Hours) 33 0 33 0 0 0
Annual IC Cost Burden (Dollars) 717 0 717 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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