Information Collection

Key Informants Interview

IC 216726 under ICR 201602-0920-007 · OMB 0920-1019.

Documents and Forms

Document Name Document Type
Key Informants Interview Form
Att 10b_Key informant interview script.docx Other-Interview Script
Interviewer Data Collection Att 10a_Interviewer data collection worksheet.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Key Informants Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	none	Interviewer Data Collection	Att 10a_Interviewer data collection worksheet.docx		No		Paper Only
Other-Interview Script			Att 10b_Key informant interview script.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	60	60
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.