Information Collection

Screening Script to Identify Supervisors for Interview

IC 183634 under ICR 200801-0920-010 · OMB 0920-0782.

Documents and Forms

Document Name Document Type
Form No number Screening Script to Identify Supervisors for Interview Form
No number Attachment C - Screening Script to Identify Supervisor Att_C Screening Script EMS Provider Survey.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Screening Script to Identify Supervisors for Interview	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	No number	Attachment C - Screening Script to Identify Supervisor	Att_C Screening Script EMS Provider Survey.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,250	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,250	2,250
Annual IC Time Burden (Hours)	75	75
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.