Attachment C -- Staff Interview Guide – Additional Staff

Evaluating and Implementing the Six Building Blocks Team Approach to Improve Opioid Management in Primary Care

Documents and Forms

Document Name Document Type
Form 3 Attachment C -- Staff Interview Guide – Additional Staff Form and Instruction
3 Staff Interview Guide Attachment C. Staff Interview Guide_Additional Staff_REVISED 12.12.19.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Attachment C -- Staff Interview Guide – Additional Staff	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	3	Staff Interview Guide	Attachment C. Staff Interview Guide_Additional Staff_REVISED 12.12.19.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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