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Administrator Interviews
Standardizing Antibiotic Use in Long-Term Care Settings (SAUL) Study
OMB: 0935-0171
IC ID: 193978
OMB.report
HHS/AHRQ
OMB 0935-0171
ICR 201007-0935-004
IC 193978
( )
Documents and Forms
Document Name
Document Type
Form Form #2
Administrator Interviews
Form and Instruction
Form #2 Administrator Interview Guide & Facility Information For
ATTACHMENT E -- Administrator Interview Guide & FACILITY INFORMATION FORM.doc
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Administrator Interviews
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 #2
Administrator Interview Guide & Facility Information Form
ATTACHMENT E -- Administrator Interview Guide & FACILITY INFORMATION FORM.doc
Yes
Yes
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:
12
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 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
12
0
12
0
0
0
Annual IC Time Burden (Hours)
3
0
3
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.