Information Collection

Key Informants Interview

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

Documents and Forms

Documents and forms in this information collection
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

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.