90-day Follow-up Interview

Community-based Organization (CBO) Monitoring and Evaluation Project (CMEP) of WILLOW (CMEP-WILLOW)

OMB: 0920-0896

IC ID: 198812

Information Collection (IC) Details

View Information Collection (IC)

90-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 90 day Follow up Survey att3a_90-Day Follow-up Survey.doc Yes Yes Fillable Fileable
Form none 90 day Follow up Survey - screenshots CMEP_WILLOW_OMB_SS_90day.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
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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