Information Collection

Interview with Nongrantee State and Local Partners

IC 208037 under ICR 201308-0920-003 · OMB 0920-0992.

Documents and Forms

Document Name Document Type
Interview with Nongrantee State and Local Partners Form
Interview with Nongrantee Partners ATT 8C Non-Grantee Partner Interview Guide 7.18.2013.docx Form
ATT 8D Informed Consent Form.docx Consent IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Interview with Nongrantee State and Local Partners	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 with Nongrantee Partners	ATT 8C Non-Grantee Partner 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 8D 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.