Information Collection

OWH Prevention Award - Provider Qualitative Interviews

IC 235506 under ICR 201708-0990-001 · OMB 0990-0379.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0379 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Provider Qualitative Interview Questions _Individuals (Providers)_final version.docx	Other-Interview
OMB_Clearance_Submission_Form_OWHPA - Erie County DOH - Provider Qualitative Interviews - SSA mini.doc OWHPA Provider Qualitative Interviews - SSA mini	IC Document

IC Title:

OWH Prevention Award - Provider Qualitative Interviews

Agency IC Tracking Number:

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
Other-Interview			Provider Qualitative Interview Questions _Individuals (Providers)_final version.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	25	25
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OWHPA Provider Qualitative Interviews - SSA mini	OMB_Clearance_Submission_Form_OWHPA - Erie County DOH - Provider Qualitative Interviews - SSA mini.doc	03/28/2019

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