Interview Guide for Key Project Staff and Stakeholders

Evaluation of the SAMHSA PDMP Electronic Health Record Integration and Interoperability Expansion Program

Documents and Forms

Document Name Document Type
Interview Guide for Key Project Staff and Stakeholders Form and Instruction
Interview Guide Attachment 3 - Key Project Staff and Stakeholders Interview Guide - Final.docx Form and Instruction
Attachment 7 - Initial Contact and Scheduling Email Templates - 9-26-2013 - Final.docx 7 - Contact Letters and Emails IC Document

Information Collection (IC) Details

IC Title:	Interview Guide for Key Project Staff and Stakeholders	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	none	Interview Guide	Attachment 3 - Key Project Staff and Stakeholders Interview Guide - Final.docx		No	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	53	53
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
7 - Contact Letters and Emails	Attachment 7 - Initial Contact and Scheduling Email Templates - 9-26-2013 - Final.docx	11/07/2013

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