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Federal forms, ICRs, and supporting documents

Information Collection

Data Collection Instrument for Interviews

IC 182368 under ICR 200911-0920-005 · OMB 0920-0762.

Documents and Forms
Document Name
Document Type
Other-WORD
Information Collection (IC) Details

View Information Collection (IC)

Data Collection Instrument for Interviews
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD 0762_Att3a.WS-Part II - Interviews_081709.doc Yes Yes Fillable Printable

Health Illness Prevention

 

144 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 144 0 0 0 0 144
Annual IC Time Burden (Hours) 144 0 0 0 0 144
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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