Information Collection

Prevention Is Care (PIC) Material Testing Interview

IC 183182 under ICR 201104-0920-002 · OMB 0920-0775.

Documents and Forms

Document Name Document Type
Prevention Is Care (PIC) Material Testing Interview Form
Prevention is Care Interview A2b Data Collection Instruments-PIC.docx Form
A5b_Consent Forms-PIC_3-1-11.doc Consent - Prevention is Care IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Prevention Is Care (PIC) Material Testing 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	none	Prevention is Care Interview	A2b Data Collection Instruments-PIC.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 48	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	Previously Approved
Annual Number of Responses for this IC	48	-6	54
Annual IC Time Burden (Hours)	48	-6	54
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Consent - Prevention is Care	A5b_Consent Forms-PIC_3-1-11.doc	03/23/2011

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