OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Healthy Weight Collaborative

IC 204420 under ICR 201210-0915-001 · OMB 0915-0358.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 1
Healthy Weight Collaborative		 Form
Informed Consent Form - Final 11-28-12.docx Other-Interview Consent
1 Phase 1 interviews
Phase 1 community team interviews.docx 		Form
2 Phase 2
Phase 2 Community Team Interviews.docx 		Form
3 NICHQ
Phase 2 NICHQ Leadership.docx 		Form
4 observation template
learning session observation template.docx 		Form

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 1 Phase 1 interviews Phase 1 community team interviews.docx No No Paper Only
Form 2 Phase 2 Phase 2 Community Team Interviews.docx Yes Yes Paper Only
Form 3 NICHQ Phase 2 NICHQ Leadership.docx Yes Yes Paper Only
Form 4 observation template learning session observation template.docx Yes Yes Paper Only
Other-Interview Consent Informed Consent Form - Final 11-28-12.docx Yes Yes Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 103 0 103 0 0 0
Annual IC Time Burden (Hours) 136 0 136 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 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.