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[NCHHSTP] Interviews with Primary Care Providers on Hepatitis C 0920-0840-25CR
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0840 Primary Care Physician - HCV Screener Att1_PCP Interview HCV Screener.docx N/A Yes Yes Fillable Fileable
Form and Instruction 0920-0840 Primary Care Physician - HCV Consent Att2_PCP Interview HCV Consent.docx N/A Yes Yes Fillable Fileable
Form and Instruction 0920-0840 Primary Care Physician - HCV Discussion Guide Att3_PCP Interview HCV Discussion Guide.docx N/A No   Fillable Fileable
Form and Instruction 0920-0840 Primary Care Physician - HCV Email Reminder Att5_PCP Interview HCV Email Reminder.docx N/A Yes Yes Fillable Fileable

Health Public Health Monitoring

 

208 0
   
Individuals or Households
 
   50 %

  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 208 0 208 0 0 0
Annual IC Time Burden (Hours) 31 0 31 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement A SSA_PCP Interview HCV.docx 01/06/2025
Supporting Statement B SSB_PCP Interview HCV.docx 01/06/2025
IRB Determination Att4_PCP Interview HCV IRB Determination.pdf 01/06/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.