Information Collection

#4 - Mentor-Coach Telephone Interview Protocol Table

IC 198050 under ICR 201201-0970-003 · OMB 0970-0399.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 4. Staff Telephone Interview Protocol_110411_FINAL.doc	Other-Attachment 4. Staff Telephone

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-Attachment 4. Staff Telephone Interview Protocol_110411_FINAL			Attachment 4. Staff Telephone Interview Protocol_110411_FINAL.doc		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 130

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	130	130
Annual IC Time Burden (Hours)	130	130
Annual IC Cost Burden (Dollars)	2,159	2,159

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.