Information Collection

Coalition Leader Interview

IC 188800 under ICR 200910-0920-006 · OMB 0920-0823.

Documents and Forms

Document Name Document Type
Form No number Coalition Leader Interview Form
No number Coalition Leader Interview Attachment F -- Coalition Leader Interview.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Coalition Leader Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	No number	Coalition Leader Interview	Attachment F -- Coalition Leader Interview.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	50	50
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.