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Patient Pilot Study Qualitative Interviews - In Depth Interview Guide for Intervention Cases

IC 208622 under ICR 201309-0915-001 · OMB 0915-0371.

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Patient Pilot Study Qualitative Interviews - In Depth Interview Guide for Intervention Cases
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Patient Interview Guide 5 AppendixO_PatientInterviewGuide.docx Yes Yes Paper Only

Health Health Care Services

 

100 0
   
Individuals or Households
 
   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 100 0 100 0 0 0
Annual IC Time Burden (Hours) 100 0 100 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
5 AppendixL_1_CaseConsent 5 AppendixL_1_CaseConsent.doc 08/30/2013
5 AppendixL_2_ControlConsent 5 AppendixL_2_ControlConsent.doc 08/30/2013
5 AppendixM_HIPAAAuthorization 5 AppendixM_HIPAAAuthorization.doc 08/30/2013
AppendixN_PocketCard AppendixN_PocketCard.docx 08/30/2013
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