Information Collection

Pre-Hospital Stroke Systems of Care: Emergency Medical Service System (EMSS) Implementation Assessment

IC 236818 under ICR 201711-0920-012 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0879 Pre-Hospital Stroke Systems of Care: Emergency Medical Service System (EMSS) Implementation Assessment Form and Instruction
0920-0879 Interview Guide Attachment B_Interview Guide.docx Form and Instruction
Attachment A_Respondent Breakdown.docx Respondent Breakdown IC Document
Attachment C_Recruitment Email.docx Recruitment Email IC Document
Attachment D_Email Reminder.docx Email Reminder IC Document
Attachment E_Confirmation Email.docx Confirmation Email IC Document
Attachment F_Followup Email.docx Followup Email IC Document
STROKE-POL-SSA final.docx SSA IC Document
STROKE-POL-SSB.docx SSB IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Pre-Hospital Stroke Systems of Care: Emergency Medical Service System (EMSS) Implementation Assessment	Agency IC Tracking Number:	0920-0879-19BKU

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	0920-0879	Interview Guide	Attachment B_Interview Guide.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 48	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	48	48
Annual IC Time Burden (Hours)	72	72
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Respondent Breakdown	Attachment A_Respondent Breakdown.docx	07/05/2019
Recruitment Email	Attachment C_Recruitment Email.docx	07/05/2019
Email Reminder	Attachment D_Email Reminder.docx	07/05/2019
Confirmation Email	Attachment E_Confirmation Email.docx	07/05/2019
Followup Email	Attachment F_Followup Email.docx	07/05/2019
SSA	STROKE-POL-SSA final.docx	07/05/2019
SSB	STROKE-POL-SSB.docx	07/05/2019

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