Information Collection

2019 SAS Telemedicine Cog Interviews

IC 234426 under ICR 201606-0607-003 · OMB 0607-0725.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0725 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 2019 SAS Telemedicine Cog Interviews	Form
1 Attachment A - Proposed Telemedicine Questions for SAS Attachment A - Proposed Telemedicine Questions for the Services Annual Survey.docx	Form
2 Attachment C - SAS Questionnaire Attachment C - Services Annual Survey.docx	Form
Telemedicine OMB Letter.docx OMB Memo	IC Document
Attachment B - Telemedicine Cognitive Interview Protocol.docx Attachment B - Cognitive Protocol	IC Document
Attachment D - Recruiting Script.docx Attachment D - Recruiting Scripts	IC Document

IC Title:

2019 SAS Telemedicine Cog Interviews

Agency IC Tracking Number:

IC Status: New

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	1	Attachment A - Proposed Telemedicine Questions for SAS	Attachment A - Proposed Telemedicine Questions for the Services Annual Survey.docx		No		Fillable Fileable
Form	2	Attachment C - SAS Questionnaire	Attachment C - Services Annual Survey.docx		No		Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Memo	Telemedicine OMB Letter.docx	12/06/2018
Attachment B - Cognitive Protocol	Attachment B - Telemedicine Cognitive Interview Protocol.docx	12/06/2018
Attachment D - Recruiting Scripts	Attachment D - Recruiting Script.docx	12/06/2018

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