Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Attachment 1 -- Evaluation Provider Survey New 60 15 0 Form and Instruction 1
Attachment 2 -- Evaluation Patient Survey New 150 38 0 Form and Instruction 2
Attachment 3 -- Evaluation Provider Interview New 10 5 0 Form and Instruction 3
Attachment 4 -- Evaluation Patient Interview New 20 10 0 Form and Instruction 4
Attachment 5 -- Evaluation Site Champion Interview New 15 8 0 Form and Instruction 5
Total burden requested under this ICR: 255 76 0  
To view an IC, click on IC Title