Information Collection

Worksheet for Identifying Case Study Interviewees

IC 226615 under ICR 201703-0920-006 · OMB 0920-1193.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1193 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Worksheet for Identifying Case Study Interviewees	Form and Instruction
Worksheet for Identifying Case Study Interviewees Att 5b_Worksheet for Identifying Case Study Interviewees.docx	Form and Instruction
Att 5a_Case Study Introductory Letter.docx Case Study Introductory Letter	IC Document
Att 5c_Case Study Introductory Email.docx Case Study Interview Introductory Email	IC Document
Att 5d_Case Study Interview Matrix.docx Case Study Interview Matrix	IC Document

IC Title:

Worksheet for Identifying Case Study Interviewees

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Form and Instruction	N/A	Worksheet for Identifying Case Study Interviewees	Att 5b_Worksheet for Identifying Case Study Interviewees.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5

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
Annual Number of Responses for this IC	5	5
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	102	102

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Case Study Introductory Letter	Att 5a_Case Study Introductory Letter.docx	05/01/2017
Case Study Interview Introductory Email	Att 5c_Case Study Introductory Email.docx	05/01/2017
Case Study Interview Matrix	Att 5d_Case Study Interview Matrix.docx	05/01/2017

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