Information Collection

Community Collaborators-Semi-Structured Interviews

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Community Collaborators-Semi-Structured Interviews	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	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 %

	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

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.