Information Collection

Community Educator Post Interview

IC 210073 under ICR 201401-0925-005 · OMB 0925-0694.

Documents and Forms

Document Name Document Type
Form 8 Community Educator Post Interview Form and Instruction
8 Community Educator Post Interview 3F - NDEP DHS Educator Post Interview_071113_OMB30.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Community Educator Post Interview	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 and Instruction	8	Community Educator Post Interview	3F - NDEP DHS Educator Post Interview_071113_OMB30.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5	5
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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