Information Collection

Program Partners- Process Interviews

IC 194097 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 1 Program Partners- Process Interviews	Form
1 Partners Process Evaluation Form Respondent-Program Partners Process Evaluation Questionnaire 9_26_10.doc	Form

IC Title:

Program Partners- Process Interviews

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form	1	Partners Process Evaluation Form	Respondent-Program Partners 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: 60

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	60	60
Annual IC Time Burden (Hours)	45	45
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.