Information Collection

Semi-structured interview

IC 193966 under ICR 201403-0935-002 · OMB 0935-0170.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0170 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Semi-structured interview	Form and Instruction
2 Semi-structured interview guide ATTACHMENT E -- Semi-structured interview guide-v2.docx	Form and Instruction
ATTACHMENT F -- AHRQ NITS Informed Consent Form-v2.docx Interview informed consent form	IC Document

IC Title:

Semi-structured interview

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	Semi-structured interview guide	ATTACHMENT E -- Semi-structured interview guide-v2.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9

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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	81	81
Annual IC Time Burden (Hours)	81	81
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Interview informed consent form	ATTACHMENT F -- AHRQ NITS Informed Consent Form-v2.docx	03/20/2014

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