Information Collection

Executives, PD/PM-Semi-Structured Interviews

IC 219462 under ICR 201601-0930-001 · OMB 0930-0355.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Exec-Admin Staff S Executives, PD/PM-Semi-Structured Interviews	Form and Instruction
Exec-Admin Staff S Exec-Admin Staff SS Interview Guide 1-VITEL Exec-Admin Staff SS Interview Guide v11.docx	Form and Instruction
2-VITEL Exec-Admin Consent Form v4.docx Exec-Admin Consent Form	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	Exec-Admin Staff SS Interview Guide	Exec-Admin Staff SS Interview Guide	1-VITEL Exec-Admin Staff SS Interview Guide v11.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Exec-Admin Consent Form	2-VITEL Exec-Admin Consent Form v4.docx	01/04/2016

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