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Patient Locator Form
[NCHHSTP] mChoice: Improving PrEP Uptake and Adherence among Minority MSM through Tailored Provider Training and Adherence Assistance in Two High Priority Settings
OMB: 0920-1428
IC ID: 263487
OMB.report
HHS/CDC
OMB 0920-1428
ICR 202402-0920-005
IC 263487
( )
Documents and Forms
Document Name
Document Type
Form 0920-22FZ
Patient Locator Form
Form and Instruction
0920-22FZ Patient Locator Form _English
Att 4b_Patient Locator Form English.docx
Form and Instruction
0920-22FZ Att 4b_Patient Locator Form Spanish
Att 4b_Patient Locator Form Spanish.docx
Form and Instruction
Information Collection (IC) Details
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