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Suggested Interviewees Form
Impact Evaluation of CDC's Colorectal Cancer Control Program
OMB: 0920-0992
IC ID: 208029
OMB.report
HHS/CDC
OMB 0920-0992
ICR 201308-0920-003
IC 208029
( )
Documents and Forms
Document Name
Document Type
Suggested Interviewees Form
Form
Site Visit Interviewee Form
ATT 6A Site Visit Suggested Interviewee Form.docx
Form
ATT 6C Grantee Site Visit Introductory Letter Email.docx
Att 6c - Grantee Intro Letter
IC Document
ATT 6D Nongrantee Site Visit Introductory Letter Email.docx
Att 6d - Non-grantee Intro Letter
IC Document
ATT 6E Site Visit Confirmation Email.docx
tt 6e - Site Visit Confirmation Letter
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Suggested Interviewees Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
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
Form
none
Site Visit Interviewee Form
ATT 6A Site Visit Suggested Interviewee Form.docx
No
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
4
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
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
4
0
4
0
0
0
Annual IC Time Burden (Hours)
4
0
4
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Att 6c - Grantee Intro Letter
ATT 6C Grantee Site Visit Introductory Letter Email.docx
07/22/2013
Att 6d - Non-grantee Intro Letter
ATT 6D Nongrantee Site Visit Introductory Letter Email.docx
07/22/2013
tt 6e - Site Visit Confirmation Letter
ATT 6E Site Visit Confirmation Email.docx
07/22/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.