Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.
Awardee Recruitment	Unchanged	220	440	0	Form	1
Health Center Patient Survey Patient Screening Form	Modified	13120	2230	0	Form	6
					Form	7 T
					Form	8 T
					Form	9 T
					Form	10 T
					Form	12
					Form	7
					Form	7 C
					Form	7 S
					Form	7 V
					Form	8
					Form	8 C
					Form	8 S
					Form	8 V
					Form	9
					Form	9 C
					Form	9 S
					Form	9 V
					Form	10
					Form	10 C
					Form	10 S
					Form	10 V
					Form	11
					Form	11 C
					Form	11 S
					Form	11 V
Health Center Patient Survey Patient Survey Instrument	Modified	9000	9000	0	Form	4 T
					Form	5
					Form	5 C
					Form	5 S
					Form	5 V
					Form	5 T
					Form	4
					Form	4 C
					Form	4 S
					Form	4 V
Patient Screening: Short Blessed Scale	Unchanged	18	1	0	Form	3
					Form	3 C
					Form	3 S
					Form	3 V
					Form	3 T
Site Recruitment and Training	Modified	700	2205	0	Form	2
Total burden requested under this ICR:		23058	13876	0
To view an IC, click on IC Title