Interview Planning Tool

Case Studies of Selected Communities and States Funded under Community Activities under the Communities Putting Prevention to Work (CPPW) Initiative

Documents and Forms

Document Name Document Type
Interview Planning Tool Form
Interview Planning Tool Attachment 7a Interview Planning Tool.doc Form
Attachment 7c Case Study FAQs for CPPW-Affordable Care Act Sites.doc Att 7c - FAQ IC Document
Attachment 7b CPPW Case Study Introductory Letter.doc Att 7b - Introductory Letter IC Document
Attachment 7d Introductory e-mail to schedule site visit preparatory call.doc Att 7d - Introductory Email IC Document
Attachment 7e Site Visit Preparatory Call.doc Att 7e - Script for Preparatory Call IC Document

Information Collection (IC) Details

IC Title:	Interview Planning Tool	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	none	Interview Planning Tool	Attachment 7a Interview Planning Tool.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	24	24
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 7c - FAQ	Attachment 7c Case Study FAQs for CPPW-Affordable Care Act Sites.doc	10/22/2010
Att 7b - Introductory Letter	Attachment 7b CPPW Case Study Introductory Letter.doc	10/22/2010
Att 7d - Introductory Email	Attachment 7d Introductory e-mail to schedule site visit preparatory call.doc	10/22/2010
Att 7e - Script for Preparatory Call	Attachment 7e Site Visit Preparatory Call.doc	10/22/2010

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