Implementation 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 2 Implementation Staff Interviews Form and Instruction
2 2012 Implementation Staff Interview Guide Attachment E- 2012 Implementation Staff Interview Guide.docx Form and Instruction
3 2014 Implementation Staff Interview Guide Attachment F - 2014 Implementation 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:	Implementation 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	2	2012 Implementation Staff Interview Guide	Attachment E- 2012 Implementation Staff Interview Guide.docx		Yes	Yes	Paper Only
Form and Instruction	3	2014 Implementation Staff Interview Guide	Attachment F - 2014 Implementation 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: 288	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	Previously Approved
Annual Number of Responses for this IC	288	0	288
Annual IC Time Burden (Hours)	576	288	288
Annual IC Cost Burden (Dollars)	0	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.