OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

One-on-One Surveys

IC 194003 under ICR 201011-0920-007 · OMB 0920-0869.

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-Interview Guide
Form and Instruction
Form and Instruction
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

One-on-One Surveys
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 3a Screening Tool 0920-09CJ_att3a_Screener for One-on-One Interviews.OADS.docx Yes Yes Fillable Fileable
Other-Interview Guide 0920-09CJ_att3b_One-on-One Interview Guide OADS.06162010.docx Yes Yes Fillable Fileable
Form and Instruction 3c Screener for One-on-One Surveys 0920-09CJ_att3c_Phase 2 Screener for One-on-One Surveys.OADS.docx Yes Yes Fillable Fileable
Form none Survey (attachment 3d) 0920-0869.Phase 2 Quantitative Survey.11012010.docx Yes No Fillable Fileable

Health Illness Prevention

 

250 0
   
Individuals or Households
 
   100 %

  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 250 0 0 0 0 250
Annual IC Time Burden (Hours) 125 0 0 0 0 125
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
IRB Approval 0920-0869_Local IRB approval.Phase 2 One-on-One Survey.docx 11/08/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.