Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Facility staff providing patient lists Modified 1030 515 0 Instruction
Facility Staff Medical Record Abstraction Modified 7488 374 0 Instruction
Instruction
Instruction
Instruction
Instruction
Facility staff Providing Estimated Patient Loads Modified 936 1872 0 Instruction
Patient Short interview Modified 299 100 0 Instruction
Patients Standard Interview Modified 7172 5379 0 Form none Patient Standard Interview
Patients approached by facility staff for enrollment Modified 3120 260 0 Instruction
Physician/Nurse/Practitioner Provider Survey Removed 0 0 0 Instruction
Total burden requested under this ICR: 20045 8500 0  
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