Project Staff Communication Form - pharmacists

Integrating Community Pharmacists and Clinical Sites for Patient-Centered HIV Care

Documents and Forms

Document Name Document Type
Project Staff Communication Form - pharmacists Form
Staff Communication Form - pharmacist Att 11a_staff communication form.docx Form

Information Collection (IC) Details

IC Title:	Project Staff Communication Form - pharmacists	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	none	Staff Communication Form - pharmacist	Att 11a_staff communication form.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	60	-80	140
Annual IC Time Burden (Hours)	30	-40	70
Annual IC Cost Burden (Dollars)	0	0	0

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.