Information Collection

Implementation Staff Interviews

IC 199921 under ICR 201402-0935-001 · OMB 0935-0190.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Implementation Staff Interviews	Form and Instruction
2 2012 Implementation Staff Interview Guide Attachment E- 2012 Implementation Staff Interview Guide.docx	Form and Instruction
3 2014 Implementation Staff Interview Guide Attachment F - 2014 Implementation Staff Interview Guide.docx	Form and Instruction
Attachment C- Interview Request and Confirmation Emails.docx Attachment C- Interview Request and Confirmation Emails	IC Document

IC Title:

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	2	2012 Implementation Staff Interview Guide	Attachment E- 2012 Implementation Staff Interview Guide.docx		Yes	Yes	Paper Only
Form and Instruction	3	2014 Implementation Staff Interview Guide	Attachment F - 2014 Implementation Staff Interview Guide.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 288

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	288	0	288
Annual IC Time Burden (Hours)	576	288	288
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment C- Interview Request and Confirmation Emails	Attachment C- Interview Request and Confirmation Emails.docx	02/18/2014

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