OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Patient Quarterly Assessment

IC 263489 under ICR 202602-0920-002 · OMB 0920-1428.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Patient Quarterly Assessment 0920-26-0026
 
Yes Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-26-0026 Quarterly Assessment English Att 4d_Patient Quarterly Assessment English_Clean.docx Yes Yes Fillable Fileable
Form and Instruction 0920-26-0026 Quarterly Assessment Spanish Att 4d_Patient Quarterly Assessment Spanish_Clean.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

134 0
   
Individuals or Households
 
   0 %

  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 402 0 0 0 0 402
Annual IC Time Burden (Hours) 302 0 0 0 0 302
Annual IC Cost Burden (Dollars) 0 0 0 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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