Information Collection

Program Staff- Process Evaluation Interview

IC 194095 under ICR 201009-0990-004 · OMB 0990-0360.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0360 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Program Staff- Process Evaluation Interview Form
1 Staff Process Evaluation Form Respondent-Program Staff Process Evaluation Questionnaire 9_26_10.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Program Staff- Process Evaluation 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	1	Staff Process Evaluation Form	Respondent-Program Staff Process Evaluation Questionnaire 9_26_10.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	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	20	20
Annual IC Time Burden (Hours)	15	15
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.