Information Collection

Individual interviews to solicit feedback on family-focused materials developed for a pediatric palliative care communications campaign

IC 218085 under ICR 201503-0925-004 · OMB 0925-0653.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0653 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Individual interviews to solicit feedback on family-focused materials developed for a pediatric palliative care communications campaign Form and Instruction
1 Appendix A InterviewRecruitment AppendixA_InterviewRecruitment FINAL.docx Form and Instruction
2 Appendix C InterviewInstrument AppendixC_InterviewInstrument_Final.docx Form
NINR_0925-0653_FastTrackClearance FINAL 9.01.15 (2).docx NINR FastTrack Clearance IC Document
AppendixB_InterviewConsent FINAL 9.01.15.docx Appendix B Interview Consent IC Document
AppendixD_AtaGlance.pdf Appendix D AtaGlance IC Document
AppendixE_FindingSupport.pdf Appendix E Finding Support IC Document
AppendixF_FamilyStories.pdf Appendix F Family Stories IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Individual interviews to solicit feedback on family-focused materials developed for a pediatric palliative care communications campaign	Agency IC Tracking Number:

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	1	Appendix A InterviewRecruitment	AppendixA_InterviewRecruitment FINAL.docx		No		Paper Only
Form	2	Appendix C InterviewInstrument	AppendixC_InterviewInstrument_Final.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 36	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
NINR FastTrack Clearance	NINR_0925-0653_FastTrackClearance FINAL 9.01.15 (2).docx	09/03/2015
Appendix B Interview Consent	AppendixB_InterviewConsent FINAL 9.01.15.docx	09/03/2015
Appendix D AtaGlance	AppendixD_AtaGlance.pdf	09/03/2015
Appendix E Finding Support	AppendixE_FindingSupport.pdf	09/03/2015
Appendix F Family Stories	AppendixF_FamilyStories.pdf	09/03/2015

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