Information Collection

Qualitative Interview

IC 180335 under ICR 200906-0920-014 · OMB 0920-0748.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Qualitative Interview	Form and Instruction
Qualitative Interview Guide for Never in Care Attachment 2b Qualitative Interview Guide and Form.doc	Form and Instruction
Attachment 5b IC for Qualitative Interview.doc Consent Form for Qualitative Interview	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	Qualitative Interview Guide for Never in Care	Attachment 2b Qualitative Interview Guide and Form.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 75

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Consent Form for Qualitative Interview	Attachment 5b IC for Qualitative Interview.doc	05/21/2007

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