Information Collection

LIA Leadership Protocol

IC 267253 under ICR 202404-0906-005 · OMB 0906-0099.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 LIA Leadership Protocol	Form and Instruction
2 LIA Leadership Interview Protocol LIA Leadership Interview Protocol.docx	Form and Instruction
2 LIA Leadership Interview Protocol Appendix I_Disparities Instrument 6_LIA Leadership Interview Protocol 08012024.docx	Form and Instruction
Appendix I_Disparities Instrument 6_LIA Leadership Interview Protocol (RL).docx Appendix I_Disparities Instrument 6_LIA Leadership Interview Protocol (RL)	IC Document

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
Form and Instruction	2	LIA Leadership Interview Protocol	Appendix I_Disparities Instrument 6_LIA Leadership Interview Protocol 08012024.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	6	6
Annual IC Time Burden (Hours)	9	9
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix I_Disparities Instrument 6_LIA Leadership Interview Protocol (RL)	Appendix I_Disparities Instrument 6_LIA Leadership Interview Protocol (RL).docx	08/01/2024

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