Information Collection

Standard Structured Interview

IC 180334 under ICR 200906-0920-014 · OMB 0920-0748.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Standard Structured Interview	Form and Instruction
Standard Structured Questionnaire for Never In Care Proj Attachment 2a Structured Questionnaire.doc	Form and Instruction
Attachment 3 Interview Guide.doc 2007 Interview Guide for Never In Care Project	IC Document
Attachment 5a IC for Structured Interview.doc Consent Form for Structured Interview	IC Document
Attachment 2c Non-Response Form.doc Non-Response Data Collection Form	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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
Form and Instruction	None	Standard Structured Questionnaire for Never In Care Project	Attachment 2a Structured Questionnaire.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2007 Interview Guide for Never In Care Project	Attachment 3 Interview Guide.doc	05/21/2007
Consent Form for Structured Interview	Attachment 5a IC for Structured Interview.doc	05/21/2007
Non-Response Data Collection Form	Attachment 2c Non-Response Form.doc	05/21/2007

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