Information Collection

Patient Navigator Pilot Survey

IC 266201 under ICR 202505-0704-008 · OMB 0704-0553.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Patient Navigator Survey.docx	Other-Web Survey
Patient Navigator Survey.docx	Other-Web Survey
One-Page Justification.docx One-Page Justification	IC Document
One-Page Justification.docx One-Page Justification	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Web Survey					Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 900

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-900	900
Annual IC Time Burden (Hours)	-75	75
Annual IC Cost Burden (Dollars)	-2,232	2,232

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
One-Page Justification		03/22/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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