Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
Interview Questionnaire	Modified	7760	5173	134015	Form and Instruction	none	2024 Programming Questionnaire - English
					Form	0920-25-0058	MMP Questionnaire
					Form	0920-25-0058	MMP Questionnaire _SPANISH
Lookup Contact Information	Unchanged	1940	65	1622	Instruction
Model Patient Recruitment Script - Facility	Unchanged	970	81	2027	Form and Instruction	none	Recruitment script
Pull Medical Records	Unchanged	7760	388	9700	Instruction
Total burden requested under this ICR:		18430	5707	147364
To view an IC, click on IC Title