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

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NINR)

⚠️ Notice: This information collection may be referencing outdated material.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 Spanish language family-focused materials developed for a pediatric palliative care communications campaign Form and Instruction
1 Appendic C Interview Script and Questions AppendixC_InterviewInstrumentsSPA.docx Form and Instruction
2 Appendix A RecruitmentPlan&ScreenerSPA AppendixA_RecruitmentPlan&ScreenerSPA.docx Form and Instruction
AppendixB_InterviewConsentSPA.docx Appendix B Interview ConsentSPA IC Document
AppendixD_AtaGlanceSPA.pdf Appendix D_AtaGlanceSPA IC Document
AppendixE_FindingSupportSPA.pdf AppendixE_Finding SupportSPA IC Document
AppendixF_FamilyStoriesSPA.pdf AppendixF_FamilyStoriesSPA IC Document
AppendixG_NoticeofOMBAction.pdf AppendixG_NoticeofOMBAction IC Document
NINR_0925-0653_FastTrackClearanceSPA.docx NINR Fast Track Clearance SPA IC Document

Information Collection (IC) Details

IC Title:	Individual interviews to solicit feedback on Spanish language 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	Appendic C Interview Script and Questions	AppendixC_InterviewInstrumentsSPA.docx		No		Fillable Fileable
Form and Instruction	2	Appendix A RecruitmentPlan&ScreenerSPA	AppendixA_RecruitmentPlan&ScreenerSPA.docx		No		Fillable Fileable

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
Appendix B Interview ConsentSPA	AppendixB_InterviewConsentSPA.docx	11/23/2015
Appendix D_AtaGlanceSPA	AppendixD_AtaGlanceSPA.pdf	11/23/2015
AppendixE_Finding SupportSPA	AppendixE_FindingSupportSPA.pdf	11/23/2015
AppendixF_FamilyStoriesSPA	AppendixF_FamilyStoriesSPA.pdf	11/23/2015
AppendixG_NoticeofOMBAction	AppendixG_NoticeofOMBAction.pdf	11/23/2015
NINR Fast Track Clearance SPA	NINR_0925-0653_FastTrackClearanceSPA.docx	11/23/2015

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