Post Visit Follow-up to Review the Workflow Process Map(s)

Patient-Reported Health Information Technology and Workflow

Documents and Forms

Document Name Document Type
Form Form #8 Post Visit Follow-up to Review the Workflow Process Map(s) Form and Instruction
Form #8 Interview Guide for Follow-Up Attachment L -- Interview Guide for Follow-Up.docx Form and Instruction
Attachment K -- Email for Follow-Up.docx Attachment K -- Email for Follow-Up IC Document

Information Collection (IC) Details

IC Title:	Post Visit Follow-up to Review the Workflow Process Map(s)	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 #8	Interview Guide for Follow-Up	Attachment L -- Interview Guide for Follow-Up.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 K -- Email for Follow-Up	Attachment K -- Email for Follow-Up.docx	05/07/2013

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