Barriers to Care Assessment for WTC Health Program Care at MSSM

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Document Name Document Type
Barriers to Care Assessment for WTC Health Program Care at MSSM Form
Barriers to Care Assessment Attachment A- Mount Sinai 2018.docx Form
Mt. Sinai 2018- submission template_08302018.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	Barriers to Care Assessment for WTC Health Program Care at MSSM	Agency IC Tracking Number:	0920-0953-18AXX

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	none	Barriers to Care Assessment	Attachment A- Mount Sinai 2018.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,100	3,100
Annual IC Time Burden (Hours)	258	258
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	Mt. Sinai 2018- submission template_08302018.docx	08/30/2018

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