Information Collection

Interview Protocol for Emergency Department and Primary Care

IC 197249 under ICR 201104-0920-007 · OMB 0920-0887.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0887 can be found here:

Documents and Forms

Document Name Document Type
clean_Attachment C--Interview Protocol 1--Emergency Department and Primary Care.doc Other-Interview Protocol
clean_Attachment E--Invitation Letter.docx Attachment E - Interview Invitation IC Document
clean_Attachment F--Follow-up Letter.docx Attachment F - Followup Letter IC Document
clean_Attachment G--Confirmation Letter.doc Attachment G - Confirmation Letter IC Document
clean_Attachment H--Thank-you Letter.doc Attachment H - Thankyou Letter IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Interview Protocol for Emergency Department and Primary Care	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
Other-Interview Protocol			clean_Attachment C--Interview Protocol 1--Emergency Department and Primary Care.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 43	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	43	43
Annual IC Time Burden (Hours)	43	43
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment E - Interview Invitation	clean_Attachment E--Invitation Letter.docx	03/17/2011
Attachment F - Followup Letter	clean_Attachment F--Follow-up Letter.docx	03/17/2011
Attachment G - Confirmation Letter	clean_Attachment G--Confirmation Letter.doc	03/17/2011
Attachment H - Thankyou Letter	clean_Attachment H--Thank-you Letter.doc	03/17/2011

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