Information Collection

Interview of SCB Owners

IC 198667 under ICR 201107-0920-009 · OMB 0920-0903.

Documents and Forms

Document Name Document Type
Attachment E - Interview probes.docx Other-Interview Script
OMB Attachment C - Interview Recruitment script.docx Interview Recruitment Script IC Document
OMB Attachment D - Interview Opening Statement.docx Interview Opening Statement / Consent IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Interview of SCB Owners	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
Other-Interview Script			Attachment E - Interview probes.docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 30

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	45	45
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Interview Recruitment Script	OMB Attachment C - Interview Recruitment script.docx	07/20/2011
Interview Opening Statement / Consent	OMB Attachment D - Interview Opening Statement.docx	07/20/2011

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