View Information Collection (IC)
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View Information Collection (IC)

Impact Evaluation Demonstration Project DDP/LCP 0920-22DZ
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-22DZ Attachment D. Screener and Survey Attachment D. Screener and Survey.docx Yes Yes Fillable Fileable
Form 0920-22DZ Attachment E. Survey Consent Attachment E. Survey Consent.docx Yes Yes Fillable Fileable
Form 0920-22DZ Attachment G. Enrollment Log Attachment G. Enrollment Log.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

805 0
   
State, Local, and Tribal Governments
 
   100 %

  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 805 0 805 0 0 0
Annual IC Time Burden (Hours) 110 0 110 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment A. Background Attachment A. Background.docx 04/04/2022
Attachment B. Justification of Remuneration Attachment B. Justification of Remuneration.docx 04/04/2022
Attachment C. Privacy and Confidentiality Attachment C. Privacy and Confidentiality.docx 04/04/2022
HMTS Expedited Review Form HMTS Expedited Review Form.docx 04/04/2022
Attachment F. Recruitment Instruments Attachment F. Recruitment Instruments.docx 04/04/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.