Information Collection

Assessment Branch (AB) Partner Data Assessment Project

IC 212676 under ICR 201407-0920-001 · OMB 0920-1026.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A - Key Informant Interview Guide.docx	Other-WORD
Attachment B - Interview Scheduling Email.docx Att B - Interview Scheduling Email	IC Document
Attachment C - Interview Confirmation Email.docx Att C _ Interview Confirmation Email	IC Document
Fast_Track_GenIC_Request Partner Data Assessment Project_final.docx Request for Approval - Customer Feedback	IC Document

IC Title:

Agency IC Tracking Number:

14AUM

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			Attachment A - Key Informant Interview Guide.docx		No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54

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	54	54
Annual IC Time Burden (Hours)	45	45
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att B - Interview Scheduling Email	Attachment B - Interview Scheduling Email.docx	08/14/2014
Att C _ Interview Confirmation Email	Attachment C - Interview Confirmation Email.docx	08/14/2014
Request for Approval - Customer Feedback	Fast_Track_GenIC_Request Partner Data Assessment Project_final.docx	08/14/2014

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