Information Collection

CCC Staff Key Informant Recruitment/Scheduling

IC 210385 under ICR 201510-0920-001 · OMB 0920-1016.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920- CCC Staff Key Informant Recruitment/Scheduling	Form and Instruction
0920- Att D4_Key_Informant_Recruitment Scheduling Att D4_Key_Informant_Recruitment Scheduling_10_29_13.docx	Form and Instruction
Att D1_Key_Informant_Interview_11_01_13.docx Att D1_Key_Informant_Interview	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	0920-	Att D4_Key_Informant_Recruitment Scheduling	Att D4_Key_Informant_Recruitment Scheduling_10_29_13.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att D1_Key_Informant_Interview	Att D1_Key_Informant_Interview_11_01_13.docx	02/11/2014

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