Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Health Center Patient Survey Patient Screening Form New 6996 1189 0 Form 1 Screener
Health Center Patient Survey Patient Survey Instrument New 6600 8250 0 Form and Instruction 1 Survey
Patient Screening Form Removed 0 0 0 Form 1 Patient Screener
Patient Survey Instrument Removed 0 0 0 Form and Instruction 1 Patient Survey
Total burden requested under this ICR: 13596 9439 0  
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