Information Collection

Suggested Interviewees Form

IC 208029 under ICR 201308-0920-003 · OMB 0920-0992.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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	none	Site Visit Interviewee Form	ATT 6A Site Visit Suggested Interviewee Form.docx		No	No	Printable Only

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4	4
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.