Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Aim 1 Provider Patient Interaction (Baseline and Final) New 10 5 0 Form and Instruction 0920-22GA Att 4e_Aim1ProviderPatientInteraction
Aim 1 Provider Post-Training Survey New 10 3 0 Form and Instruction 0920-22GA Att 4d_Aim1ProviderPostTrainingSurvey
Aim 1 Provider Pre- Training Survey New 10 3 0 Form and Instruction 0920-22GA Att 4c_Aim1ProviderPreTrainingSurvey
Aim 1 Provider Training Contact Information New 10 1 0 Form and Instruction 0920-22GA Att 4b_Aim1ProviderTrainingContactInformation
Aim 1 Provider Training Screener New 20 2 0 Form and Instruction 0920-22GA Att 4a_Aim1ProviderTrainingScreener
Aim 2a Cohort App Setup (English/Spanish) New 134 67 0 Form and Instruction 0920-22GA Att 4j_Aim2aCohortAppSetupEnglishSpanish
Aim 2a Cohort Baseline Survey (English/Spanish) New 134 101 0 Form and Instruction 0920-22GA Att 4i_Aim2aCohortBaselineSurveyEnglish
Form and Instruction 0920-22GA Att 4i_Aim2aCohortBaselineSurveySpanish
Aim 2a Cohort Blood Collection Instructions (English/Spanish) New 134 134 0 Form and Instruction 0920-22GA Att 4l_Aim2a Cohort Blood Collection Instructions English
Aim 2a Cohort Contact Information (English/Spanish) New 134 11 0 Form and Instruction 0920-22GA Att 4b_Aim1ProviderTrainingContactInformation
Aim 2a Cohort Exit Interview (English/Spanish) New 15 15 0 Form and Instruction 0920-22GA Att 4m_Aim2a Cohort Exit Interview English
Form and Instruction 0920-22GA Att 4m_Aim2aCohortExitInterviewSpanish
Aim 2a Cohort Follow-up Survey (English/Spanish) New 134 302 0 Form and Instruction 0920-22GA Att 4k_Aim2aCohortFollowUpSurveyEnglish
Form and Instruction 0920-22GA Att 4k_Aim2aCohortFollowUpSurveySpanish
Aim 2a Cohort HIPAA Form (English & Spanish) New 134 11 0 Form and Instruction 0920-22GA Att 4h_Aim2aCohortHIPAAFormEnglish
Form and Instruction 0920-22GA Att 4h_Aim2aCohortHIPAAFormSpanish
Aim 2a Cohort Screener (English/Spanish) New 267 22 0 Form and Instruction 0920-22GA Att 4f_Aim2aCohortScreenerEnglish
Form and Instruction 0920-22GA Att 4f_Aim2aCohortScreenerSpanish
Aim 2b Provider Focus Group Contact Information New 16 1 0 Form and Instruction 0920-22GA Att 4o_Aim2b Provider FocusGroup Contact Information
Aim 2b Provider Focus Group Guide New 16 32 0 Form and Instruction 0920-22GA Att 4o_Aim2b Provider FocusGroup Contact Information
Aim 2b Provider Focus Group Screener New 32 3 0 Form and Instruction 0920-22GA Att_4n_Aim2bProvider FocusGroup Screener
Aim 2b Provider Pre-Focus Group Survey New 16 1 0 Form and Instruction 0920-22GA Att 4p_Aim2b Provider Pre FocusGroup Survey
Aims 1&2 Clinic Assessment (Baseline & Final) New 9 18 0 Form and Instruction 0920-22GA Att 4r_Aim1&2ClinicAssessmentBaselineAndFinal
Aims 1&2 Clinic Assessment (every 6 months) New 9 27 0 Form and Instruction 0920-22GA Aims 1&2 Clinic Assessment (every 6 months)
Total burden requested under this ICR: 1244 759 0  
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