Information Collection

Peer Workers Interview

IC 213437 under ICR 201410-0930-002 · OMB 0930-0345.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Telephone Intervie Peer Workers Interview	Form
Telephone Intervie Telephone Interview Attachment 2 Telephone Interview.docx	Form
Attachment 5 Letter to Interview Participants.docx Letter to Interview Participants	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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
Form	Telephone Interview	Telephone Interview	Attachment 2 Telephone Interview.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Letter to Interview Participants	Attachment 5 Letter to Interview Participants.docx	10/09/2014

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