Information Collection

Genomics and Population Health Action Collaborative (GPHAC) Interviews

IC 225110 under ICR 201606-0920-007 · OMB 0920-0974.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
GPHAC Questions for States.docx	Other-WORD
Emails to be sent to states.docx Emails	IC Document
GenIC_RequestforApproval_state_interviews..docx Request for Approval	IC Document

IC Title:

Agency IC Tracking Number:

17IR

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
Other-WORD					No		Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

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	40	40
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Emails		01/11/2017
Request for Approval		01/11/2017

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

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