OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Using Peer Mentors to Support PACT Team Efforts to Improve Diabetes

IC 212920 under ICR 201409-2900-005 · OMB 2900-0840.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Using Peer Mentors to Support PACT Team Efforts to Improve Diabetes
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 10-10138 Monthly Script Mentor Questions 20151001_V4_PeerMntorDiabetes_MonthlyScriptPeerMentor_8-16-2012 v2.docx No   Paper Only
Form and Instruction 10-10138 ICF Mentor 20151014_V4_PeerMntorDiab_ICF_Mentor_6-10-14_Clean.doc No   Paper Only
Form and Instruction 10-10138 Mentoring Instruments - Baseline survey, 6 mo. survey, 12 mo. survey, 18 mo. survey 10-10138 S4 VISN 4 Peer Mentoring Instruments_rev20151001 v2.docx No   Paper Only
Form and Instruction 10-10138 ICF Usual Care Mentee Stage 1 20151014_V4_PeerMntorDiab_ICF_UsualCareMenteeStageI_4-2-2015_clean.doc No   Paper Only
Form and Instruction 10-10138 Qualitative Interview Questions 1-8 20151014_V4_PeerMntorDiab_qualIntrvw_1thru8_7-10-13.doc No   Paper Only
Form and Instruction 10-10138 ICF Usual Care Mentee Stage 2 20151014_V4_PeerMntorDiab_ICF_UsualCareMenteeStageII_6-10-2014_Clean.doc No   Paper Only

Health Health Care Services

 

5,170 0
   
Individuals or Households
 
   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 5,170 0 5,170 0 0 0
Annual IC Time Burden (Hours) 1,472 0 1,472 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.