Interview with Medical Care Providers

Research to Reduce Time to Treatment for Heart Attack/Myocardial Infarction for Rural American Indians/Alaska Natives (AI/AN)

Documents and Forms

Document Name Document Type
Att 9A. Medical Providers Interview Guide.doc Other-Interview Guide
Att 9B. Consent Form for Medical Providers Interview.doc Attachment 9B - consent form IC Document

Information Collection (IC) Details

IC Title:	Interview with Medical Care Providers	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
Other-Interview Guide			Att 9A. Medical Providers Interview Guide.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 27	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	27	27
Annual IC Time Burden (Hours)	27	27
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 9B - consent form	Att 9B. Consent Form for Medical Providers Interview.doc	07/14/2008

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