Information Collection

Interview of SCB Owners

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

Documents and Forms

Documents and forms in this information collection
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

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.