Information Collection

Qualitative semi-structured interviews with frontline staff

IC 247673 under ICR 202105-0935-001 · OMB 0935-0246.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form J3 Qualitative semi-structured interviews with frontline staff	Form and Instruction
Appendix J5-Handout 1 List of Tier 2 Toolkit.docx	Instruction
Appendix J5-Handout 1 List of Tier 2 Toolkit.docx	Instruction
Appendix J6-Handout 2 Online Modules.docx	Instruction
Appendix J6-Handout 2 Online Modules.docx	Instruction
J3 Interview guide for qualitative interviews with AIM Team Appendix J3-BaselineInterviewGuide_12_16_20.docx	Form and Instruction
J3 Interview guide for qualitative interviews with AIM Team Appendix J3-BaselineInterviewGuide_12_16_20.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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	J3	Interview guide for qualitative interviews with AIM Team Leads & frontline staff (summer/fall 2021)	Appendix J3-BaselineInterviewGuide_12_16_20.docx	Yes	Yes	Fillable Fileable
Instruction			Appendix J5-Handout 1 List of Tier 2 Toolkit.docx	Yes	No	Paper Only
Instruction			Appendix J6-Handout 2 Online Modules.docx	Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 32

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	32	32
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	0	0

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.