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Patient Qualitative Interview
Feasibility of secure messaging for pediatric patients with chronic disease: Pilot implementation in pediatric respiratory medicine
OMB: 0935-0141
IC ID: 184804
OMB.report
HHS/AHRQ
OMB 0935-0141
ICR 200805-0935-002
IC 184804
( )
Documents and Forms
Document Name
Document Type
Form Form #3
Patient Qualitative Interview
Form and Instruction
Form #3 Qualitative Interview
ATTACHMENT E --Draft Qualitative Interview Questions.doc
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Patient Qualitative 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 and Instruction
Form #3
Qualitative Interview
ATTACHMENT E --Draft Qualitative Interview Questions.doc
No
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
30
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
30
0
30
0
0
0
Annual IC Time Burden (Hours)
15
0
15
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.