Appendix C1. PD Interview Guide

Evaluation of Learning Health Systems K12 Training Program

Documents and Forms

Document Name Document Type
Form C1 Appendix C1. PD Interview Guide Form
C1 Appendix C1. PD Interview Guide Appendix C1. PD Discussion Guide_5-18-20.docx Form
Appendix C2. PD Invitation Email.docx Appendix C2. PD Invitation Email IC Document
Appendix C3. PD FAQs.docx Appendix C3. PD Study Description/FAQs IC Document
Appendix C4. PD Invitation Reminder Email.docx Appendix C4. PD Invitation Reminder Email IC Document
Appendix C5. PD Recruitment Telephone Script.docx Appendix C5. PD Telephone Recruitment Script IC Document
Appendix C6. PD Scheduling Email.docx Appendix C6. PD Scheduling Email IC Document
Appendix C7. PD Confirmation Email.docx Appendix C7. PD Confirmation Email IC Document
Appendix C8. PD Interview Reminder Email.docx Appendix C8. PD Reminder Email IC Document
Appendix C9. PD Reminder Telephone Script.docx Appendix C9. PD Reminder Telephone Script IC Document
Appendix C10. PD Thank You Email.docx Appendix C10. PD Thank-You Email IC Document

Information Collection (IC) Details

IC Title:	Appendix C1. PD Interview Guide	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	C1	Appendix C1. PD Interview Guide	Appendix C1. PD Discussion Guide_5-18-20.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4	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: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4	4
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix C2. PD Invitation Email	Appendix C2. PD Invitation Email.docx	06/05/2020
Appendix C3. PD Study Description/FAQs	Appendix C3. PD FAQs.docx	06/05/2020
Appendix C4. PD Invitation Reminder Email	Appendix C4. PD Invitation Reminder Email.docx	06/05/2020
Appendix C5. PD Telephone Recruitment Script	Appendix C5. PD Recruitment Telephone Script.docx	06/05/2020
Appendix C6. PD Scheduling Email	Appendix C6. PD Scheduling Email.docx	06/05/2020
Appendix C7. PD Confirmation Email	Appendix C7. PD Confirmation Email.docx	06/05/2020
Appendix C8. PD Reminder Email	Appendix C8. PD Interview Reminder Email.docx	06/05/2020
Appendix C9. PD Reminder Telephone Script	Appendix C9. PD Reminder Telephone Script.docx	06/05/2020
Appendix C10. PD Thank-You Email	Appendix C10. PD Thank You Email.docx	06/05/2020

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