Information Collection

Interview Guide for Grantee Evaluators

IC 208032 under ICR 201308-0920-003 · OMB 0920-0992.

Documents and Forms

Document Name Document Type
Interview Guide for Grantee Evaluators Form
Interview Guide for Grantee Evaluators ATT 7B Grantee Evaluator Interview Guide 7.18.2013.docx Form
ATT 7D Informed Consent Form.docx Consent IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Interview Guide for Grantee Evaluators	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	Interview Guide for Grantee Evaluators	ATT 7B Grantee Evaluator Interview Guide 7.18.2013.docx		No	No	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

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 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

Title	Document	Date Uploaded
Consent	ATT 7D Informed Consent Form.docx	07/22/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.