Information Collection

Other Key Staff Site Visit Interview

IC 218982 under ICR 201511-0925-003 · OMB 0925-0734.

Documents and Forms

Document Name Document Type
Form 12 Other Key Staff Site Visit Interview Form and Instruction
12 Attachment 7 Key Staff Interview Protocol Attachment 7. Key Staff Interview Protocol.docx Form and Instruction
13 Attachment 9 Evaluator Interview Protocol Attachment 8. Evaluator Interview Protocol.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Other Key Staff Site Visit 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
Form and Instruction	12	Attachment 7 Key Staff Interview Protocol	Attachment 7. Key Staff Interview Protocol.docx		No		Fillable Fileable
Form and Instruction	13	Attachment 9 Evaluator Interview Protocol	Attachment 8. Evaluator Interview Protocol.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90	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	90	90
Annual IC Time Burden (Hours)	135	135
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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