Information Collection

NCCAM Professional Association Leadership Interview Guide

IC 200575 under ICR 201012-0925-002 · OMB 0925-0530.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NCCAM Professional Association Leadership Interview Guide	Form and Instruction
1 Interview Guide NCCAM Interview Guide for omb.docx	Form and Instruction
NCCAM generic_clearance_form 112911[1].docx NCCAM generic_clearance_form 112911[1]	IC Document
NCCAM cover memo 112911[1].docx NCCAM cover memo 112911[1]	IC Document

IC Title:

Agency IC Tracking Number:

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 and Instruction	1	Interview Guide	NCCAM Interview Guide for omb.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	30	0	0	0	0	0
Annual IC Time Burden (Hours)	15	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NCCAM generic_clearance_form 112911[1]	NCCAM generic_clearance_form 112911[1].docx	12/21/2011
NCCAM cover memo 112911[1]	NCCAM cover memo 112911[1].docx	12/21/2011

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