Information Collection

Qualitative Study of Factors that Influence Healthcare Seeking in Pilots: Enrollment and Interviews

IC 262831 under ICR 202310-0701-002 · OMB 0701-0172.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0701-TPHB_Qualtrics Enrollment Screener.docx	Other-Screener Survey
0701-TPHB_Qualtrics Enrollment Screener.docx	Other-Screener Survey
0701-TPHB_semi-structured interview guide.docx	Other-Interview Guide
0701-TPHB_semi-structured interview guide.docx	Other-Interview Guide

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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-Screener Survey			0701-TPHB_Qualtrics Enrollment Screener.docx		Yes	Yes	Fillable Fileable
Other-Interview Guide			0701-TPHB_semi-structured interview guide.docx		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	4,000	4,000

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.