Clinic Staff Interviews

Assessment and Evaluation of the Role of Care Coordination (Case Management) in Improving Access and Care within the Spina Bifida Clinic System

Documents and Forms

Document Name Document Type
Clinic Staff Interviews Form and Instruction
Interview Guide for Clinic Director Attachment C12-Interview Guide Clinic Director.doc Form and Instruction
Interview Guide for Clinician Provider Attachment C14-Interview Guide Clinician Provider.doc Form and Instruction
Interview Guide for Care Coordinator Attachment C13-Interview Guide Care Coordinator.doc Form and Instruction
Interview Guide for Clinic Staff Attachment C15-Interview Guide Clinic Staff.doc Form and Instruction
Att C16 C17 C19 and C20-Recruitment_Confirmation_Consent.doc Staff Interview Recruitment, Consent and Confirmation Materials IC Document

Information Collection (IC) Details

IC Title:	Clinic Staff Interviews	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Interview Guide for Clinic Director	Attachment C12-Interview Guide Clinic Director.doc	No	No	Paper Only
Form and Instruction	None	Interview Guide for Clinician Provider	Attachment C14-Interview Guide Clinician Provider.doc	No	No	Paper Only
Form and Instruction	None	Interview Guide for Care Coordinator	Attachment C13-Interview Guide Care Coordinator.doc	No	No	Paper Only
Form and Instruction	None	Interview Guide for Clinic Staff	Attachment C15-Interview Guide Clinic Staff.doc	No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Staff Interview Recruitment, Consent and Confirmation Materials	Att C16 C17 C19 and C20-Recruitment_Confirmation_Consent.doc	06/17/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.