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Attachment B -- Staff Interview Guide – QI Lead
Evaluating and Implementing the Six Building Blocks Team Approach to Improve Opioid Management in Primary Care
OMB: 0935-0248
IC ID: 237127
OMB.report
HHS/AHRQ
OMB 0935-0248
ICR 201907-0935-003
IC 237127
( )
Documents and Forms
Document Name
Document Type
Form 2
Attachment B -- Staff Interview Guide – QI Lead
Form and Instruction
2 Attachment B -- Staff Interview Guide – QI Lead
Attachment B. Staff Interview Guide_QI Lead_REVISED 12.12.19.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Attachment B -- Staff Interview Guide – QI Lead
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
2
Attachment B -- Staff Interview Guide – QI Lead
Attachment B. Staff Interview Guide_QI Lead_REVISED 12.12.19.docx
Yes
Yes
Fillable Fileable
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:
15
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
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)
30
0
30
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.