Information Collection

Screening Script to Identify Supervisors for Interview

IC 183634 under ICR 200801-0920-010 · OMB 0920-0782.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form No number Screening Script to Identify Supervisors for Interview	Form
No number Attachment C - Screening Script to Identify Supervisor Att_C Screening Script EMS Provider Survey.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	No number	Attachment C - Screening Script to Identify Supervisor	Att_C Screening Script EMS Provider Survey.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,250

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,250	2,250
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.