Information Collection

Interview 3-Month Follow-up

IC 194319 under ICR 201008-0920-009 · OMB 0920-0872.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 3d_3 mth Follow-up Qualitative Interview Guide.07092010.docx	Other-Interview Guidelines
Attachment 3d_3 mth Follow-up Qualitative Interview Guide 11012010.docx	Other-Interview Guidelines

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Other-Interview Guidelines			Attachment 3d_3 mth Follow-up Qualitative Interview Guide.07092010.docx		Yes	No	Paper Only
Other-Interview Guidelines			Attachment 3d_3 mth Follow-up Qualitative Interview Guide 11012010.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	225	225
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.