Interviews with Practice Manager and Physician Leader

Patient-Reported Health Information Technology and Workflow

Documents and Forms

Document Name Document Type
Form Form #4 Interviews with Practice Manager and Physician Leader Form and Instruction
Form #4 Guide for Interview with Practice Manager Attachment D -- Guide for Interview with Practice Manager.docx Form and Instruction
Form #4B Guide for Interview with Physician Leader Attachment E -- Guide for Interview with Physician Leader.docx Form and Instruction
Attachment O -- Information Sheet for Practice Managers.docx Attachment O -- Information Sheet for Practice Managers IC Document
Attachment P -- Information Sheet for Clinicians.docx Attachment P -- Information Sheet for Clinicians IC Document

Information Collection (IC) Details

IC Title:	Interviews with Practice Manager and Physician Leader	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 #4	Guide for Interview with Practice Manager	Attachment D -- Guide for Interview with Practice Manager.docx		Yes	Yes	Paper Only
Form and Instruction	Form #4B	Guide for Interview with Physician Leader	Attachment E -- Guide for Interview with Physician Leader.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

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 Agency Discretion
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment O -- Information Sheet for Practice Managers	Attachment O -- Information Sheet for Practice Managers.docx	05/07/2013
Attachment P -- Information Sheet for Clinicians	Attachment P -- Information Sheet for Clinicians.docx	05/07/2013

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