Information Collection

In-Person Interviews

IC 195902 under ICR 201101-0930-002 · OMB 0930-0322.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Interviews and sur In-Person Interviews	Form and Instruction
Interviews and sur Interviews and survey-instruments Interviews and Survey Instruments.pdf	Form and Instruction
In-person training In-person training material-instruments In Person Training Material-Instruments.pdf	Form and Instruction
Interviews and Survey-Other.pdf Interviews and Survey-Other	IC Document

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
Form and Instruction	Interviews and survey-instruments	Interviews and survey-instruments	Interviews and Survey Instruments.pdf		Yes	Yes	Paper Only
Form and Instruction	In-person training material-instruments	In-person training material-instruments	In Person Training Material-Instruments.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	360	360
Annual IC Time Burden (Hours)	61	61
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Interviews and Survey-Other	Interviews and Survey-Other.pdf	04/07/2011

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