Information Collection

Att D_ Law Enforcement Officials (Interview)

IC 191865 under ICR 201601-0920-004 · OMB 0920-0604.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0604 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att D_Law Enforcement Interview Instrument.docx	Other-CATI
Att F_Law Enforcement Participation Letter.docx Att F_Law Enforcement Paricipation Request Letter	IC Document

IC Title:

Att D_ Law Enforcement Officials (Interview)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 242

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
Other-CATI			Att D_Law Enforcement Interview Instrument.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 35

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	35	0	35
Annual IC Time Burden (Hours)	38	3	35
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att F_Law Enforcement Paricipation Request Letter	Att F_Law Enforcement Participation Letter.docx	01/12/2016

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