Information Collection

Individual Interview Questions (Family Spotlights)

IC 217716 under ICR 201511-0925-006 · OMB 0925-0729.

Documents and Forms

Document Name Document Type
Form 8 Individual Interview Questions (Family Spotlights) Form and Instruction
8 Attachment C Individual Interview Questions (Family Spot Attachment C_Individual Interview Questions (Family Spotlights).docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Individual Interview Questions (Family Spotlights)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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 and Instruction	8	Attachment C Individual Interview Questions (Family Spotlights)	Attachment C_Individual Interview Questions (Family Spotlights).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3	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	3	3
Annual IC Time Burden (Hours)	6	6
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.