Information Collection

Aspr Tracie Covid-19 Hcc

IC 246454 under ICR 201807-0990-004 · OMB 0990-0391.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0391 ASPR TRACIE Attachment A - COVID-19 HCC Survey.docx	Other-Survey
0990-0391 ASPR TRACIE Attachment B - COVID-19 HCC Interview Guide.docx	Other-Interview Guide
0990-0391 ASPR TRACIE Attachment C - COVID-19 HCC Recruitment Message.docx Recruitment Message	IC Document
PRA Generic Form HCC COVID-19 Assessment 3.23.21.docx IC HCC COVID-19 Assessment	IC Document
SSA_0990-0391 Generic ASPR TRACIE COVID-19 HCC Surveys_Interviews 3.24.21.docx Part A - COVID-19 Healthcare Coalitions Survey and Interviews	IC Document
SSB_0990-0391 Generic ASPR TRACIE COVID-19 HCC 3.23.21.docx Part B - COVID-19 Healthcare Coalitions Survey and Interviews	IC Document
Tracie irb approval.pdf IRB Approval	IC Document

IC Title:

ASPR TRACIE COVID-19 HCC

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-Survey					Yes	Yes	Fillable Fileable
Other-Interview Guide					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 402

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	402	402
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Recruitment Message		03/25/2021
IC HCC COVID-19 Assessment		03/25/2021
Part A - COVID-19 Healthcare Coalitions Survey and Interviews		03/25/2021
Part B - COVID-19 Healthcare Coalitions Survey and Interviews		03/25/2021
IRB Approval		04/05/2021

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

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