Information Collection

Semi- structured interview

IC 215073 under ICR 201701-0990-003 · OMB 0990-0428.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-NEW _PAF Instrument 1_Master Topic Guide.docx	Other-Master guide
0990-NewAttachment A_ Overview of the PAF Evaluation.docx Overview of The PAF Study	IC Document
0990_new PAF_Attachment B_Person Consulted.docx Persons Consulted on Instrument Development	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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
Other-Master guide			0990-NEW _PAF Instrument 1_Master Topic Guide.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	16	16
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Overview of The PAF Study	0990-NewAttachment A_ Overview of the PAF Evaluation.docx	02/24/2015
Persons Consulted on Instrument Development	0990_new PAF_Attachment B_Person Consulted.docx	02/24/2015

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