Information Collection

State Key Informant Interviews

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.