Patient Interview Guide

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

OMB: 0935-0179

IC ID: 233775

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Information Collection (IC) Details

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Patient Interview Guide
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Patient Interview Guide Attachment E_Patient Interview Guide_101818.docx No   Paper Only

Health Health Care Services

 

18 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Requested 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 18 0 0 0 0 18
Annual IC Time Burden (Hours) 9 0 0 0 0 9
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Fast Track Supporting Statement Fast Track Submission_Patient Interview Guide_101818.doc 10/29/2018
Total Overview Supporting Statement_101818.doc 10/29/2018
Cover Letter Cover Page Patient Interview Guide.doc 10/29/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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