Information Collection

Interviews

IC 181870 under ICR 200709-0930-001 · OMB 0930-0289.

Documents and Forms

Document Name Document Type
Form Surveys Interviews Form and Instruction
Surveys Surveys Surveys.zip Form and Instruction
Letters.zip Letters IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	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
Form and Instruction	Surveys	Surveys	Surveys.zip		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 177	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	177	177
Annual IC Time Burden (Hours)	620	620
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letters	Letters.zip	08/23/2007

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