Information Collection

Key Informants

IC 199550 under ICR 201307-0925-004 · OMB 0925-0649.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 7 Key Informant Interview Protocol Key Informants	Form and Instruction
7 Key Informant Interview Protocol FINAL_HCS_SSA_ATTACH 13_KI PROTOCOL_Jan 2013.docx	Form and Instruction

IC Title:

Key Informants

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	7	Key Informant Interview Protocol	FINAL_HCS_SSA_ATTACH 13_KI PROTOCOL_Jan 2013.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,056

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,056	-2,246	3,302
Annual IC Time Burden (Hours)	2,376	-431	2,807
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.