Information Collection

Interview Guide

IC 237208 under ICR 202206-0920-009 · OMB 0920-1274.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1274 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1274 Interview Guide: Million Hearts® Hospital or Health System Recognition Program JUL2022 Interview Guide	Form and Instruction
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

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Interview Guide					Yes	No	Paper Only
Form and Instruction	0920-1274			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 %

table that charts list of burden
	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

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.

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