Information Collection

Pre/Post-Test Interview Protocol

IC 192330 under ICR 201408-0935-001 · OMB 0935-0164.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Old - Form #1 Pre/Post-Test Interview Protocol	Form and Instruction
Old - Form #1 Old - Pre/Post-Test Interview Protocol Attachment D -- Pre & post-test interview protocol 10-9-09.doc	Form and Instruction
Form 1 Pre-post interview protocol Attachment B -- Pre-post interview protocol.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	Old - Form #1	Old - Pre/Post-Test Interview Protocol	Attachment D -- Pre & post-test interview protocol 10-9-09.doc		Yes	Yes	Paper Only
Form and Instruction	Form 1	Pre-post interview protocol	Attachment B -- Pre-post interview protocol.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 180

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	180	180
Annual IC Time Burden (Hours)	180	180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.