Information Collection

Interviews with Clinicians Caring for WTCHP Members

IC 237332 under ICR 201907-0920-006 · OMB 0920-1280.

Documents and Forms

Document Name Document Type
Interviews with Clinicians Caring for WTCHP Members Form and Instruction
WTCHP Impact Assessment and Strategic Planning In-depth Att D_Interview guide 2019-07-30.docx Form and Instruction
WTCHP Brief Demographic Survey Att G_Brief Demo Survey_2019-07-26.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Interviews with Clinicians Caring for WTCHP Members	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	n/a	WTCHP Brief Demographic Survey	Att G_Brief Demo Survey_2019-07-26.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	n/a	WTCHP Impact Assessment and Strategic Planning In-depth Interview Discussion Guide	Att D_Interview guide 2019-07-30.docx		No		Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2	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: 99 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2	2
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	140	140

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.