Site Visit Discussion Guide - Providers

[NCCDPHP] WISEWOMAN National Program Evaluation

Documents and Forms

Document Name Document Type
Attachment D3 Clinical provider protocol.docx Other-Discussion Guide
Attachment D3 Clinical provider protocol.docx Other-Discussion Guide

Information Collection (IC) Details

IC Title:	Site Visit Discussion Guide - Providers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Discussion Guide			Attachment D3 Clinical provider protocol.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	16	16
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	1,529	1,529

Documents for IC

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.