Information Collection

R40 Interview Protocol

IC 209770 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
R40 Interview Protocol.docx	Instruction

IC Title:

R40 Interview Protocol

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Instruction			R40 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: 10

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	10	-10	20
Annual IC Time Burden (Hours)	15	-5	20
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.