Information Collection

Get Alarmed North Carolina! 6-month pre-intervention telephone survey - Pre/Post Evaluation Survey

IC 190628 under ICR 200909-0920-002 · OMB 0920-0730.

Documents and Forms

Document Name Document Type
Form 2 Get Alarmed North Carolina! 6-month pre-intervention telephone survey - Pre/Post Evaluation Survey Form and Instruction
2 Get Alarmed North Carolina! 6-month pre-intervention tel Appendix D2 - Post-Intervention Survey.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Get Alarmed North Carolina! 6-month pre-intervention telephone survey - Pre/Post Evaluation Survey	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	2	Get Alarmed North Carolina! 6-month pre-intervention telephone survey - Pre/Post Evaluation Survey	Appendix D2 - Post-Intervention Survey.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 360	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	720	720
Annual IC Time Burden (Hours)	180	180
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.