Pre-Workflow Toolkit Interview

Workflow Assessment for Health IT Toolkit Evaluation

Documents and Forms

Document Name Document Type
Form Form #1 Pre-Workflow Toolkit Interview Form and Instruction
Form #1 Attachment A - Pre-Workflow Toolkit Interview Guide Prac Attachment A -- Pre-Workflow Toolkit Interview Guide Practice.docx Form and Instruction
Form #2 Attachment B - Pre-Workflow Toolkit Interview Guide REC Attachment B -- Pre-Workflow Toolkit Interview Guide REC.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Pre-Workflow Toolkit Interview	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	Attachment A - Pre-Workflow Toolkit Interview Guide Practice	Attachment A -- Pre-Workflow Toolkit Interview Guide Practice.docx		Yes	Yes	Paper Only
Form and Instruction	Form #2	Attachment B - Pre-Workflow Toolkit Interview Guide REC	Attachment B -- Pre-Workflow Toolkit Interview Guide REC.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 258	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	258	258
Annual IC Time Burden (Hours)	129	129
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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