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Clinic Recruitment
Assessment and Evaluation of the Role of Care Coordination (Case Management) in Improving Access and Care within the Spina Bifida Clinic System
OMB: 0920-0759
IC ID: 181191
OMB.report
HHS/CDC
OMB 0920-0759
ICR 200707-0920-003
IC 181191
( )
Documents and Forms
Document Name
Document Type
Clinic Recruitment
Form and Instruction
Clinic Recruitment Script
Attachment C11-Clinic Recruitment Script.doc
Form and Instruction
Attachment C9-C10--Clinic Recruitment Letter & Brochure.doc
Clinic Recruitment Letter and Brochure
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Clinic Recruitment
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
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
Form and Instruction
None
Clinic Recruitment Script
Attachment C11-Clinic Recruitment Script.doc
No
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
14
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
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
14
0
14
0
0
0
Annual IC Time Burden (Hours)
4
0
4
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Clinic Recruitment Letter and Brochure
Attachment C9-C10--Clinic Recruitment Letter & Brochure.doc
06/17/2007
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.