Key Staff Interviews

Evaluation of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Quality Demonstration Grant Program

Documents and Forms

Document Name Document Type
Form Form #1 Key Staff Interviews Form and Instruction
Form #1 Key Staff Interview Guide Attachment B_KeyStaff Interview Guide.docx Form and Instruction
1 2014 Key Staff Interview Guide Attachment D - 2014 Key Staff Interview Guide.docx Form and Instruction
Attachment C- Interview Request and Confirmation Emails.docx Attachment C- Interview Request and Confirmation Emails IC Document

Information Collection (IC) Details

IC Title:	Key Staff Interviews	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Key Staff Interview Guide	Attachment B_KeyStaff Interview Guide.docx		Yes	Yes	Paper Only
Form and Instruction	1	2014 Key Staff Interview Guide	Attachment D - 2014 Key Staff Interview Guide.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 72	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	Previously Approved
Annual Number of Responses for this IC	144	144
Annual IC Time Burden (Hours)	216	216
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment C- Interview Request and Confirmation Emails	Attachment C- Interview Request and Confirmation Emails.docx	02/18/2014

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