Information Collection

Interview with Grantee State and Local Partners

IC 208038 under ICR 201308-0920-003 · OMB 0920-0992.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Interview with Grantee State and Local Partners	Form
Interview with Grantee Partners ATT 7C Grantee Partner Interview Guide 7.18.2013.docx	Form
ATT 7D Informed Consent Form.docx Consent	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	Interview with Grantee Partners	ATT 7C 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 %

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
Consent	ATT 7D Informed Consent Form.docx	07/31/2013

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