Information Collection

Appendix D: Post-Implementation Interview Protocol- Providers

IC 224299 under ICR 201610-0935-001 · OMB 0935-0235.

Documents and Forms

Document Name Document Type
Form 4 Appendix D: Post-Implementation Interview Protocol- Providers Form and Instruction
4 Appendix D: Post-Implementation Interview Protocol- Prov Appendix D_ InterviewGuides_Providers_rev20161031.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Appendix D: Post-Implementation Interview Protocol- Providers	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	4	Appendix D: Post-Implementation Interview Protocol- Providers	Appendix D_ InterviewGuides_Providers_rev20161031.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24	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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	48	48
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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