Information Collection

Iz Core

IC 214212 under ICR 201402-0920-018 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att. A Interview Guide.docx	Other-WORD
IZ-CORE-SSA.docx Supporting Statement A	IC Document
IZ-CORE-SSB.docx Supporting Statement B	IC Document
Att. B Invitation and Overview.docx Attachment B_Invitation and Overview	IC Document
Att. C Reminder Email.docx Attachment C_ Reminder E-mail	IC Document
Att. D Confirmation.docx Attachment D_Confirmation	IC Document
Att. E Thank You Email.docx Attachment E_Thank You Email	IC Document

IC Title:

IZ CORE

Agency IC Tracking Number:

15CB

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
Other-WORD			Att. A Interview Guide.docx		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 64

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	64	64
Annual IC Time Burden (Hours)	64	64
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	IZ-CORE-SSA.docx	12/10/2014
Supporting Statement B	IZ-CORE-SSB.docx	12/10/2014
Attachment B_Invitation and Overview	Att. B Invitation and Overview.docx	12/10/2014
Attachment C_ Reminder E-mail	Att. C Reminder Email.docx	12/10/2014
Attachment D_Confirmation	Att. D Confirmation.docx	12/10/2014
Attachment E_Thank You Email	Att. E Thank You Email.docx	12/10/2014

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