Information Collection

State PATH Contact

IC 199303 under ICR 201109-0930-001 · OMB 0930-0332.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Site Visit Intervi State PATH Contact	Form and Instruction
Site Visit Intervi Site Visit Interview Guide Attachment_A_PATH_Site_Visit_Interview_Guide_State_PATH_Contact[1].docx	Form and Instruction

IC Title:

State PATH Contact

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
Form and Instruction	Site Visit Interview Guide	Site Visit Interview Guide	Attachment_A_PATH_Site_Visit_Interview_Guide_State_PATH_Contact[1].docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	11	11
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.