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Topic Guide for Semi-Structured Telephone Interview
Survey of 911 Emergency Treatment for Heart Disease and Stroke
OMB: 0920-0782
IC ID: 183636
OMB.report
HHS/CDC
OMB 0920-0782
ICR 200801-0920-010
IC 183636
( )
Documents and Forms
Document Name
Document Type
Form No number
Topic Guide for Semi-Structured Telephone Interview
Form
No number Attachment F - Topic Guide for Semi-Structured Telephone
Att_F Semi-Structured Interview.doc
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Topic Guide for Semi-Structured Telephone 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 F - Topic Guide for Semi-Structured Telephone Interview
Att_F Semi-Structured Interview.doc
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
10
0
10
0
0
0
Annual IC Time Burden (Hours)
8
0
8
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
