Information Collection

Interview Protocol for Emergency Department and Primary Care

IC 197249 under ICR 201104-0920-007 · OMB 0920-0887.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0887 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
clean_Attachment C--Interview Protocol 1--Emergency Department and Primary Care.doc	Other-Interview Protocol
clean_Attachment E--Invitation Letter.docx Attachment E - Interview Invitation	IC Document
clean_Attachment F--Follow-up Letter.docx Attachment F - Followup Letter	IC Document
clean_Attachment G--Confirmation Letter.doc Attachment G - Confirmation Letter	IC Document
clean_Attachment H--Thank-you Letter.doc Attachment H - Thankyou Letter	IC Document

IC Title:

Interview Protocol for Emergency Department and Primary Care

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
Other-Interview Protocol			clean_Attachment C--Interview Protocol 1--Emergency Department and Primary Care.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 43

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	43	43
Annual IC Time Burden (Hours)	43	43
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment E - Interview Invitation	clean_Attachment E--Invitation Letter.docx	03/17/2011
Attachment F - Followup Letter	clean_Attachment F--Follow-up Letter.docx	03/17/2011
Attachment G - Confirmation Letter	clean_Attachment G--Confirmation Letter.doc	03/17/2011
Attachment H - Thankyou Letter	clean_Attachment H--Thank-you Letter.doc	03/17/2011

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