Information Collection

Environmental Scan Semi-Structured Interview Guide

IC 221025 under ICR 201604-0935-001 · OMB 0935-0232.

Documents and Forms

Document Name Document Type
Form 1 Environmental Scan Semi-Structured Interview Guide Form and Instruction
1 Environmental Scan Semi-Structured Interview Guide Attachment A -- FINAL 3-23-16.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Environmental Scan Semi-Structured Interview Guide	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	1	Environmental Scan Semi-Structured Interview Guide	Attachment A -- FINAL 3-23-16.docx		No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	100	100
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.