Information Collection

Attachment D: Learning Collaborative Staff Interview

IC 243377 under ICR 202107-0935-002 · OMB 0935-0258.

Documents and Forms

Document Name Document Type
Form 4 Attachment D: Learning Collaborative Staff Interview Form and Instruction
4 Attachment D: Learning Collaborative Staff Interview Attachment D_Learning Collaborative Staff Interview_05-04-2020.docx Form and Instruction
4 Attachment D: Learning Collaborative Staff Interview Attachment D_Learning Collaborative Staff Interview_05-04-2020.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment D: Learning Collaborative Staff Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	4	Attachment D: Learning Collaborative Staff Interview	Attachment D_Learning Collaborative Staff Interview_05-04-2020.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 48	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	96	96
Annual IC Time Burden (Hours)	48	48
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.