OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

180-day Follow-up Interview

IC 198829 under ICR 201406-0920-004 · OMB 0920-0895.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

180-day Follow-up Interview
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none 180 day follow-up survey att3b_180-Day Follow-up Survey.docx Yes Yes Fillable Fileable
Form none 180 day follow up survey screenshots CMEP-RESPECT QDS Screen Shots 180-day Follow-up.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

320 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 320 0 0 0 0 320
Annual IC Time Burden (Hours) 96 0 0 0 0 96
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.