Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
CCL Group Discussion New 27 54 2376 Form and Instruction n/a
CCL Health Department Interview New 17 26 1122 Form and Instruction n/a
CCL Partner Site-Level Informant Interview New 15 15 870 Form and Instruction n/a
CQM Group Discussion New 27 54 2376 Form and Instruction n/a
CQM Health Department Interview New 17 26 1122 Form and Instruction n/a
CQM Partner Site-Level Interview New 15 15 945 Form and Instruction n/a
Cost Study Resource Use and Cost Inventory Tool – Partner/Site Level New 17 34 1870 Form and Instruction n/a
Cost Study Resource Use and Cost Study Inventory Tool - Health Departments New 8 16 656 Form and Instruction n/a
MTM Health Department Interview New 8 12 528 Form and Instruction n/a
MTM Partner Site-Level Interview New 7 7 560 Form and Instruction n/a
Form and Instruction n/a
Recipient-Led Evaluation Annual Report Template New 51 408 14688 Form and Instruction n/a
Form and Instruction n/a
Form and Instruction n/a
TBC Group Discussion New 27 54 2376 Form and Instruction n/a
TBC Health Department Interview New 9 14 594 Form and Instruction n/a
TBC Partner Site-Level Interview New 8 8 432 Form and Instruction n/a
Total burden requested under this ICR: 253 743 30515  
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