Information Collection

Guinea KAP Household Member Interview

IC 216472 under ICR 201505-0920-001 · OMB 0920-1062.

Documents and Forms

Document Name Document Type
Guinea KAP Household Member Interview Form
Household Member Interview - English Att6-GuineaKAP InfoCollectInstrmnt HH 20150507 clean.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Guinea KAP Household Member Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	None	Household Member Interview - English	Att6-GuineaKAP InfoCollectInstrmnt HH 20150507 clean.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,000	6,000
Annual IC Time Burden (Hours)	6,000	6,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.