Interview Guide for End Users

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

Documents and Forms

Document Name Document Type
Interview Guide for End Users Form and Instruction
Interview Guide Attachment 4 - Clinical End Users Interview Guide - Final.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Interview Guide for End Users	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 4 - Clinical End Users 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: 59	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	59	59
Annual IC Time Burden (Hours)	59	59
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.