Information Collection

Community Collaborators-Semi-Structured Interviews

IC 219467 under ICR 201601-0930-001 · OMB 0930-0355.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Partner-Collab SS Community Collaborators-Semi-Structured Interviews	Form and Instruction
Partner-Collab SS Partner-Collab SS Interview Guide 5-VITEL Partner-Collab SS Interview Guide v10.docx	Form and Instruction
6-VITEL Partner Collaborator Consent Form v4.docx Collaborator 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	Partner-Collab SS Interview Guide	Partner-Collab SS Interview Guide	5-VITEL Partner-Collab SS Interview Guide v10.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: 100 %

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)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Collaborator Consent Form	6-VITEL Partner Collaborator 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.