Information Collection

Control Site leadership - Site visit Interview

IC 196134 under ICR 201107-0990-004 · OMB 0990-0371.

Documents and Forms

Document Name Document Type
0990-0371Attach 5 SiteVisit_Control (2).doc Other-survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Control Site leadership - Site visit 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
Other-survey			0990-0371Attach 5 SiteVisit_Control (2).doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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	50	35	15
Annual IC Time Burden (Hours)	100	70	30
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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