Information Collection

State Key Informant Interviews

IC 213246 under ICR 201409-0930-002 · OMB 0930-0347.

Documents and Forms

Document Name Document Type
Form State KII State Key Informant Interviews Form and Instruction
State KII State KII Attachment A_State KII_PCP.docx Form and Instruction
Attachment I_Key Infomant Interview Recruitment Script.docx Key Infomant Interview Recruitment Script IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Key Informant Interviews	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	State KII	State KII	Attachment A_State KII_PCP.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14	14
Annual IC Time Burden (Hours)	14	14
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Key Infomant Interview Recruitment Script	Attachment I_Key Infomant Interview Recruitment Script.docx	09/25/2014

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