Information Collection

Patient Qualitative Interview

IC 217100 under ICR 201503-0990-003 · OMB 0990-0439.

Documents and Forms

Document Name Document Type
0990-email MHPPPI-ClientQualitativeInterviewGuide_FINAL.docx Other-interview
0990_MHPPPI IRB_approval.pdf IRB IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Patient Qualitative Interview	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
Other-interview			0990-email MHPPPI-ClientQualitativeInterviewGuide_FINAL.docx		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	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	20	20
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
IRB	0990_MHPPPI IRB_approval.pdf	10/30/2015

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