Information Collection

Staff Semi-Structured Interviews

IC 205425 under ICR 201301-0935-001 · OMB 0935-0208.

Documents and Forms

Document Name Document Type
Form Form #2 Staff Semi-Structured Interviews Form and Instruction
Form #2 Staff Interview Guide Attachment D -- Staff Interview Guide.doc Form and Instruction
Attachment L -- Consent Form to Participate in Clinic Staff Interview.docx Attachment L -- Consent Form to Participate in Clinic Staff Interview IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Staff Semi-Structured Interviews	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 #2	Staff Interview Guide	Attachment D -- Staff Interview Guide.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 36	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	84	84
Annual IC Time Burden (Hours)	84	84
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment L -- Consent Form to Participate in Clinic Staff Interview	Attachment L -- Consent Form to Participate in Clinic Staff Interview.docx	01/11/2013

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