Interview Guide for Local HD Representative

Examining how Local Health Departments Leverage Age-Friendly Cities Initiatives to Build Resilience in Elderly Populations

Documents and Forms

Document Name Document Type
Attachment_F_Interview_Guide_LHD_Representatives.docx Instruction
Attachment_I_Recruitment_Letter_for_LHD_Representatives.docx Recruitment Letter for LHD Representatives IC Document

Information Collection (IC) Details

IC Title:	Interview Guide for Local HD Representative	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
Instruction			Attachment_F_Interview_Guide_LHD_Representatives.docx		Yes	No	Paper Only

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8	8
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Recruitment Letter for LHD Representatives	Attachment_I_Recruitment_Letter_for_LHD_Representatives.docx	07/29/2015

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