18. Attachment T - Provider Interview Protocol

Implementation and Testing of Diagnostic Safety Resources

Documents and Forms

Document Name Document Type
Form 18 18. Attachment T - Provider Interview Protocol Form and Instruction
18 Provider Interview Protocol Attachment T - Provider Interview Protocol.2024_5_24.docx Form and Instruction
18 Provider Interview Protocol Attachment T - Provider Interview Protocol.2024_5_24.docx Form and Instruction

Information Collection (IC) Details

IC Title:	18. Attachment T - Provider 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	18	Provider Interview Protocol	Attachment T - Provider Interview Protocol.2024_5_24.docx		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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	50	50
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

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.