Ryan White HIV/AIDS Program Outcomes and Expanded Insurance Coverage Guides

Ryan White HIV/AIDS Program Outcomes and Expanded Insurance Coverage

Documents and Forms

Document Name Document Type
Form 1 Ryan White HIV/AIDS Program Outcomes and Expanded Insurance Coverage Guides Form
1 Medical chart/record abstraction sample selection guide Medical chart abstraction guide.docx Form
2 Focus Groups Focus group guide .docx Form and Instruction
3 Site interviews (site administrators) SIte interview guide .docx Form and Instruction
4 Site Survey Site survey.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Ryan White HIV/AIDS Program Outcomes and Expanded Insurance Coverage Guides	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Medical chart/record abstraction sample selection guide	Medical chart abstraction guide.docx	Yes	Yes	Fillable Fileable
Form and Instruction	2	Focus Groups	Focus group guide .docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	Site interviews (site administrators)	SIte interview guide .docx	Yes	Yes	Fillable Fileable
Form and Instruction	4	Site Survey	Site survey.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 440	Number of Respondents for Small Entity: 20

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	440	440
Annual IC Time Burden (Hours)	418	418
Annual IC Cost Burden (Dollars)	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.