Household Member Interview

Racial and Ethnic Approaches to Community Health across the U.S. (REACH U.S.) Evaluation

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0805 can be found here:

Documents and Forms

Document Name Document Type
Attachment 3b. Family Member Interview.doc Other-Telephone Interview Script

Information Collection (IC) Details

IC Title:	Household Member Interview	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-Telephone Interview Script			Attachment 3b. Family Member Interview.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26,100	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	26,100	26,100
Annual IC Time Burden (Hours)	6,525	6,525
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.