Interview with Community Representatives

Formative Research for and Community Uptake of the Eagle Books and Youth Books for American Indians and Alaska Natives

Documents and Forms

Document Name Document Type
Interview with Community Representatives Form
Community Representative Interview Guide C-1 Comm Rep Interview Guide.doc Form
C-3 Comm Rep Consent Form.doc Att C3 - Consent for Community Reps IC Document
C-2 Comm Rep Information Sheet.doc Att C2 - Info Sheet for Community Reps IC Document

Information Collection (IC) Details

IC Title:	Interview with Community Representatives	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	Community Representative Interview Guide	C-1 Comm Rep Interview Guide.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	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
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att C3 - Consent for Community Reps	C-3 Comm Rep Consent Form.doc	07/20/2011
Att C2 - Info Sheet for Community Reps	C-2 Comm Rep Information Sheet.doc	07/20/2011

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