Learning Collaborative QI Champion Interview (Attachment C)

Identifying and Testing Strategies for Management of Opioid Use and Misuse in Older Adults in Primary Care Practices

Documents and Forms

Document Name Document Type
Form 3 Learning Collaborative QI Champion Interview (Attachment C) Form and Instruction
3 Learning Collaborative QI Champion Interview Attachment C. Champion Interview Guide 4.1.20.docx Form and Instruction
3 Learning Collaborative QI Champion Interview Attachment C. Champion Interview Guide 4.1.20.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Learning Collaborative QI Champion Interview (Attachment C)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	3	Learning Collaborative QI Champion Interview	Attachment C. Champion Interview Guide 4.1.20.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24	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	72	72
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	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.