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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	IZ CORE	Agency IC Tracking Number:	15CB

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
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 %

	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

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.