Information Collection

Interviewer Administrative Forms (Attachment 9)

IC 201514 under ICR 201510-0925-005 · OMB 0925-0654.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 9 Interviewer Administrative Forms (Attachment 9)	Form and Instruction
9 Administrative forms for the Interviewer Attach 9 -_Admin_forms_interviewers_REV_07_02_12.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	9	Administrative forms for the Interviewer	Attach 9 -_Admin_forms_interviewers_REV_07_02_12.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 19

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-2,204	2,204
Annual IC Time Burden (Hours)	-1,102	1,102
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.