Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Focus Group of Caregivers New 32 48 0 Form and Instruction 1
Inteerview Protocol for Local Agency Staff-Ongoing Only New 28 28 0 Form and Instruction 1
Interview Protocol for Data Staff New 6 9 0 Form and Instruction 1
Interview Protocol for Local Agency Director New 14 14 0 Form and Instruction 1
Interview Protocol for Local Agency Medical Staff New 14 14 0 Form and Instruction 1
Interview Protocol for Local Agency Staff-Frontline Only New 28 28 0 Form and Instruction 1
Interview Protocol for Local Agency Staff-Frontline and Ongoing New 15 19 0 Form and Instruction 1
Survey Instrument for Local Agency Staff-Form A General New 140 70 0 Form and Instruction 1
Survey Instrument for Local Agency Staff-Form B Differential Response New 50 25 0 Form and Instruction 1
Survey Instrument for Local Agency Staff-Form B General New 90 45 0 Form and Instruction 1
Survey Instrument for Service Providers New 12 6 0 Form and Instruction 1
Total burden requested under this ICR: 429 306 0  
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