Information Collection

Appendix E: Post-test Evaluation Interview Protocol

IC 255657 under ICR 202208-0935-001 · OMB 0935-0263.

Documents and Forms

Document Name Document Type
Form 5 Appendix E: Post-test Evaluation Interview Protocol Form and Instruction
5 Appendix E: Post-test Evaluation Interview Protocol E_Post_test Interview 5.17.docx Form and Instruction
5 Appendix E: Post-test Evaluation Interview Protocol E_Post_test Interview 5.17.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Appendix E: Post-test Evaluation Interview Protocol	Agency IC Tracking Number:

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	5	Appendix E: Post-test Evaluation Interview Protocol	E_Post_test Interview 5.17.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	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
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

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