Information Collection

DSMES Professional Team Member Interview

IC 241405 under ICR 201910-0920-009 · OMB 0920-1312.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
DSMES Professional Team Member Interview	Form and Instruction
DSMES Site-Level Rapid Evaluation - Semi-Structured Inte Att 4e. DSMES Prof Team Interview_30Day_v2.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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
Form and Instruction	n/a	DSMES Site-Level Rapid Evaluation - Semi-Structured Interview Guide, Professional Team Members	Att 4e. DSMES Prof Team Interview_30Day_v2.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 28

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	28	28
Annual IC Time Burden (Hours)	56	56
Annual IC Cost Burden (Dollars)	2,296	2,296

Documents for IC

table that charts IC Documents
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.