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View Information Collection (IC)

Provider Feedback for Chlamydia Prevention and Control Online Resources 15GA
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none Yes No Fillable Printable
Instruction Yes No Fillable Printable
Form and Instruction none Yes No Fillable Printable

Health Consumer Health and Safety

 

52 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 52 0 52 0 0 0
Annual IC Time Burden (Hours) 37 0 37 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Request for Approval - screener 01/26/2015
Request for approval - moderator's guide 01/26/2015
Talking points for recruitment 01/26/2015
Supporting Statements 01/26/2015
Email 01/26/2015
Recruitment flyer 01/26/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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