Att 16_CBA Key Informant Interview Script

Capacity Building Assistance Program: Assessment and Quality Control

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1099 can be found here:

Documents and Forms

Document Name Document Type
Att 16 InterviewScript.docx Other-WORD
Att 15 InterviewEmail.docx Att15_CBA Key Informant Interview Email IC Document

Information Collection (IC) Details

IC Title:	Att 16_CBA Key Informant Interview Script	Agency IC Tracking Number:	15NR

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
Other-WORD			Att 16 InterviewScript.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att15_CBA Key Informant Interview Email	Att 15 InterviewEmail.docx	08/21/2015

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