Information Collection

State Innovation in Care Integration State Grantees Interview Protocol

IC 209768 under ICR 201703-0915-001 · OMB 0915-0335.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0335 can be found here:

Documents and Forms

Document Name Document Type
2016 State Innovation in Care Integration Grantee Interview Protocol.docx Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Innovation in Care Integration State Grantees Interview Protocol	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Instruction			2016 State Innovation in Care Integration Grantee Interview Protocol.docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4	-9	13
Annual IC Time Burden (Hours)	4	-6	10
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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