Information Collection

Semi-structured telephone interview for end users who are stakeholders in PROMIS

IC 202511 under ICR 201112-0925-001 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Semi-structured telephone interview for end users who are stakeholders in PROMIS	Form and Instruction
1 Survey PROMIS Semi-structured Interview Questions FINAL.docx	Form and Instruction
KAI for PROMIS Survey OMB Form_FINAL (2).DOCX KAI for PROMIS Survey OMB Form_FINAL (2)	IC Document

IC Title:

Semi-structured telephone interview for end users who are stakeholders in PROMIS

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	Survey	PROMIS Semi-structured Interview Questions FINAL.docx		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15

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	15	0	0	0	0	0
Annual IC Time Burden (Hours)	10	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
KAI for PROMIS Survey OMB Form_FINAL (2)	KAI for PROMIS Survey OMB Form_FINAL (2).DOCX	05/30/2012

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