Information Collection

Interview with Community Leaders

IC 185916 under ICR 200807-0920-005 · OMB 0920-0797.

Documents and Forms

Document Name Document Type
Att 7A. Community Leaders Interview Guide.doc Other-Interview Guide for Community
Att 7B. Consent Form for Community Leaders Interview.doc Consent Form for Community Leaders IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Interview with Community Leaders	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-Interview Guide for Community Leaders			Att 7A. Community Leaders Interview Guide.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	11	11
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Consent Form for Community Leaders	Att 7B. Consent Form for Community Leaders Interview.doc	07/16/2008

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