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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.