Qualitative Study of Factors that Influence Healthcare Seeking in Pilots: Enrollment and Interviews

Qualitative Study of Factors that Influence Healthcare Seeking in Pilots

Documents and Forms

Document Name Document Type
0701-TPHB_Qualtrics Enrollment Screener.docx Other-Screener Survey
0701-TPHB_Qualtrics Enrollment Screener.docx Other-Screener Survey
0701-TPHB_semi-structured interview guide.docx Other-Interview Guide
0701-TPHB_semi-structured interview guide.docx Other-Interview Guide

Information Collection (IC) Details

IC Title:	Qualitative Study of Factors that Influence Healthcare Seeking in Pilots: Enrollment and Interviews	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
Other-Screener Survey			0701-TPHB_Qualtrics Enrollment Screener.docx		Yes	Yes	Fillable Fileable
Other-Interview Guide			0701-TPHB_semi-structured interview guide.docx		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	4,000	4,000

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.