Information Collection

Health Care Provider Interviews

IC 199923 under ICR 201402-0935-001 · OMB 0935-0190.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 8 Health Care Provider Interviews	Form and Instruction
8 2012 Health Care Organization Staff Interview Guides Attachment I - 2012 Health Care Provider Interview Guide.docx	Form and Instruction
9 2014 Health Care Organization Staff Interview Guide Attachment J -2014 Health Care Organization 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	8	2012 Health Care Organization Staff Interview Guides	Attachment I - 2012 Health Care Provider Interview Guide.docx		Yes	Yes	Paper Only
Form and Instruction	9	2014 Health Care Organization Staff Interview Guide	Attachment J -2014 Health Care Organization 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: 216

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	432	216	216
Annual IC Time Burden (Hours)	324	162	162
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.