Information Collection

Semi-structured interview

IC 193966 under ICR 201507-0935-002 · OMB 0935-0170.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Semi-structured interview	Form and Instruction
2 Semi-structured interview guide ATTACHMENT E -- Semi-structured interview guide rev091415.docx	Form and Instruction
ATTACHMENT F -- AHRQ NITS Informed Consent Form-v2.docx Interview informed consent form	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	2	Semi-structured interview guide	ATTACHMENT E -- Semi-structured interview guide rev091415.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	81	81
Annual IC Time Burden (Hours)	81	81
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Interview informed consent form	ATTACHMENT F -- AHRQ NITS Informed Consent Form-v2.docx	09/17/2015

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