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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 1 Appendix A InterviewRecruitment Individual interviews to solicit feedback on family-focused materials developed for a pediatric palliative care communications campaign	Form and Instruction
Form 2 Appendix C InterviewInstrument Individual interviews to solicit feedback on family-focused materials developed for a pediatric palliative care communications campaign	Form
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

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:

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	1				No		Paper Only
Form	2				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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
NINR FastTrack Clearance		09/03/2015
Appendix B Interview Consent		09/03/2015
Appendix D AtaGlance		09/03/2015
Appendix E Finding Support		09/03/2015
Appendix F Family Stories		09/03/2015

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

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