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Federal forms, ICRs, and supporting documents

Information Collection

Interview Protocol for Emergency Department and Primary Care

IC 197249 under ICR 201105-0920-002 · OMB 0920-0887.

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Interview Protocol for Emergency Department and Primary Care
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Interview Protocol for ED and PC clean_Attachment C--Interview Protocol 1--Emergency Department and Primary Care.doc No No Paper Only

Health Health Care Services

 

43 0
   
Private Sector Businesses or other for-profits
 
   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 43 0 43 0 0 0
Annual IC Time Burden (Hours) 43 0 43 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att E - Interview Invitation clean_Attachment E--Invitation Letter.docx 05/04/2011
Att G - Confirmation Letter clean_Attachment G--Confirmation Letter.doc 05/04/2011
Att F - Followup Letter clean_Attachment F--Follow-up Letter.docx 05/04/2011
Att H - Thank-you Letter clean_Attachment H--Thank-you Letter.doc 05/04/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.