Telephone Interview Guide for Infection Preventionist, Clinic Director, or Other as Referred

Healthcare Facilities Granting State Health Departments Access to Electronic Health Record Data during a Healthcare-Associated Infection Outbreak: A Retrospective Assessment

Documents and Forms

Document Name Document Type
Telephone Interview Guide for Infection Preventionist, Clinic Director, or Other as Referred Form and Instruction
Telephone Interview Guide for Infection Preventionist, C Appendix D_Interview Guide Infection Preventionist Clinic Director Raber 01 21 15.docx Form and Instruction
Appendix J_Requesting Participation_Final_.docx Individual Email to Infection Preventionists, Informatics Directors, and Others as Referred IC Document
Appendix K Reminder email_Final_.docx Individual Email Reminder to Infection Preventionists, Informatics Directors, Others as Referred, and Clinic Directors IC Document
Appendix L_Thank you_Final.docx Thank You Email to Participants IC Document
Appendix I__Clinic Directors_Final_Raber.docx Individual Email to Clinic Directors IC Document

Information Collection (IC) Details

IC Title:	Telephone Interview Guide for Infection Preventionist, Clinic Director, or Other as Referred	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	None	Telephone Interview Guide for Infection Preventionist, Clinic Director, or Other as Referred	Appendix D_Interview Guide Infection Preventionist Clinic Director Raber 01 21 15.docx	None	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Individual Email to Infection Preventionists, Informatics Directors, and Others as Referred	Appendix J_Requesting Participation_Final_.docx	02/25/2015
Individual Email Reminder to Infection Preventionists, Informatics Directors, Others as Referred, and Clinic Directors	Appendix K Reminder email_Final_.docx	02/25/2015
Thank You Email to Participants	Appendix L_Thank you_Final.docx	02/25/2015
Individual Email to Clinic Directors	Appendix I__Clinic Directors_Final_Raber.docx	02/25/2015

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