Post-Consultation Questionnaire

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

OMB: 0920-1361

IC ID: 249805

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-WORD version of content to fac
Other-WORD version of content to fac
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Post-Consultation Questionnaire
 
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 Post-Consultation Questionnaire (screenshots) Att 14b_Post-consultation questionnaire_screenshots.docx Yes Yes Fillable Fileable
Other-WORD version of content to facilitate review Att 14a_Post-consultation questionnaire.docx No   Paper Only

Health Illness Prevention

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

3 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 12 0 12 0 0 0
Annual IC Time Burden (Hours) 2 0 2 0 0 0
Annual IC Cost Burden (Dollars) 198 0 198 0 0 0

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