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Screening Script to Identify Supervisors for Interview
Survey of 911 Emergency Treatment for Heart Disease and Stroke
OMB: 0920-0782
IC ID: 183634
OMB.report
HHS/CDC
OMB 0920-0782
ICR 200801-0920-010
IC 183634
( )
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Screening Script to Identify Supervisors for Interview
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
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
Federal Enterprise Architecture Business Reference Module
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 %
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
2,250
0
2,250
0
0
0
Annual IC Time Burden (Hours)
75
0
75
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.
