Information Collection

Staff Interview Guide – Implementation Phase (months 1,3,5)

IC 252002 under ICR 202202-0920-001 · OMB 0920-1379.

Documents and Forms

Document Name Document Type
Form 0920- Staff Interview Guide – Implementation Phase (months 1,3,5) Form and Instruction
0920- Staff Survey -- Implementation Phase Toolkit Materials T Att 3e Staff Intvw - Impl Phase 1,3,5.docx Form and Instruction
Att 8 RCE Impl Manual.docx RCE Implementation Manual IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Staff Interview Guide â Implementation Phase (months 1,3,5)	Agency IC Tracking Number:	0920-21HI

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-	Staff Survey -- Implementation Phase Toolkit Materials Testing (Months 1, 3, 5)	Att 3e Staff Intvw - Impl Phase 1,3,5.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
RCE Implementation Manual	Att 8 RCE Impl Manual.docx	03/09/2022

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