ED professionals survey

Assessment of the Emergency Severity Index (ESI)

Documents and Forms

Document Name Document Type
Form Form #1 ED professionals survey Form and Instruction
Form #1 ED professionals survey Attachment B -- ED Professionals Survey.pdf Form and Instruction
Attachment G - Cover Letter for Telephone Survey.doc Attachment G - Cover Letter for Telephone Survey IC Document
Attachment I- One Week Postcard.doc Attachment I- One Week Postcard IC Document
Attachment J- One Week Email.doc Attachment J- One Week Email IC Document
Attachment K- One Week Phone.doc Attachment K- One Week Phone IC Document
Attachment L- Three Week Postcard.doc Attachment L- Three Week Postcard IC Document
Attachment M- Three Week Email.doc Attachment M- Three Week Email IC Document
Attachment N- Three Week Phone.doc Attachment N- Three Week Phone IC Document
Attachment F - Cover Letter for Email and Mail Survey.doc Attachment F - Cover Letter for Email and Mail Survey IC Document

Information Collection (IC) Details

IC Title:	ED professionals survey	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 #1	ED professionals survey	Attachment B -- ED Professionals Survey.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 405	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: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	405	405
Annual IC Time Burden (Hours)	135	135
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment G - Cover Letter for Telephone Survey	Attachment G - Cover Letter for Telephone Survey.doc	04/03/2008
Attachment I- One Week Postcard	Attachment I- One Week Postcard.doc	04/03/2008
Attachment J- One Week Email	Attachment J- One Week Email.doc	04/03/2008
Attachment K- One Week Phone	Attachment K- One Week Phone.doc	04/03/2008
Attachment L- Three Week Postcard	Attachment L- Three Week Postcard.doc	04/03/2008
Attachment M- Three Week Email	Attachment M- Three Week Email.doc	04/03/2008
Attachment N- Three Week Phone	Attachment N- Three Week Phone.doc	04/03/2008
Attachment F - Cover Letter for Email and Mail Survey	Attachment F - Cover Letter for Email and Mail Survey.doc	04/03/2008

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.