Semi-structured Individual Interview - Z-CAN Physicians

Monitoring & Evaluation for the Zika Contraception Access Network (Z-CAN)

Documents and Forms

Document Name Document Type
Semi-structured Individual Interview - Z-CAN Physicians Form and Instruction
Individual Interview Guide - Physicians English Att K-1 Interview Guide_Physicians (Eng).docx Form and Instruction
Individual Interview Guide - Physicians Spanish Att K-2 Interview Guide_Physicians (Span).docx Form and Instruction

Information Collection (IC) Details

IC Title:	Semi-structured Individual Interview - Z-CAN Physicians	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	NA	Individual Interview Guide - Physicians English	Att K-1 Interview Guide_Physicians (Eng).docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Individual Interview Guide - Physicians Spanish	Att K-2 Interview Guide_Physicians (Span).docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 25	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: 10 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	25	25
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.