Interview Guide

Million Hearts® Hospital/Health System Recognition Program

Documents and Forms

Document Name Document Type
19TG Att 2b. Comms Interview Guide Final.docx Other-Interview Guide
19TG Att 2b. Comms Interview Guide Final.docx Other-Interview Guide
0920-1274 Interview Guide: Million Hearts® Hospital or Health Syst 1274 Att 2c Interview Gde.docx Form and Instruction
0920-1274 Interview Guide: Million Hearts® Hospital or Health Syst 1274 Att 2c Interview Gde.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Interview Guide	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-Interview Guide			19TG Att 2b. Comms Interview Guide Final.docx		Yes	No	Paper Only
Form and Instruction	0920-1274	Interview Guide: Million Hearts® Hospital or Health System Recognition Program JUL2022	1274 Att 2c Interview Gde.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	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: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	30	-30	60
Annual IC Time Burden (Hours)	15	-15	30
Annual IC Cost Burden (Dollars)	806	-805	1,611

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.