Member Checking (Validation) Session Interview Guide

Understanding Health System Approaches to Chronic Pain Management

Documents and Forms

Document Name Document Type
Form 0920 Member Checking (Validation) Session Interview Guide Form and Instruction
0920 Member Checking (Validation) Session Interview Guide Att. E Member Checking Session.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Member Checking (Validation) Session Interview Guide	Agency IC Tracking Number:	0920-21IE

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	0920	Member Checking (Validation) Session Interview Guide	Att. E Member Checking Session.docx		No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 17	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	17	17
Annual IC Time Burden (Hours)	17	17
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.