Information Collection

Venue Brief Intercept Interview

IC 181804 under ICR 200708-0920-002 · OMB 0920-0760.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
APPENDIX 5 venue interview.doc	Other-Venue Brief Intercept Intervie
APPENDIX 3-1 venue intercept consent .doc Verbal Consent Script	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Venue Brief Intercept Interview			APPENDIX 5 venue interview.doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 125

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	125	125
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Verbal Consent Script	APPENDIX 3-1 venue intercept consent .doc	07/23/2007

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