In-person interviews

Improving Patient Flow and Reducing Emergency Department Crowding

Documents and Forms

Document Name Document Type
Form Form #1 In-person interviews Form and Instruction
Form #1 In-person interview Guide Attachment C -- In-person Interview Guide.doc Form and Instruction
Attachment E -- Recruitment Letter.doc Attachment E -- Recruitment Letter IC Document
Attachment F -- Informed Consent.doc Attachment F -- Informed Consent IC Document

Information Collection (IC) Details

IC Title:	In-person 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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form #1	In-person interview Guide	Attachment C -- In-person Interview Guide.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6	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	72	72
Annual IC Time Burden (Hours)	72	72
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment E -- Recruitment Letter	Attachment E -- Recruitment Letter.doc	03/19/2009
Attachment F -- Informed Consent	Attachment F -- Informed Consent.doc	03/19/2009

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