Genomics and Population Health Action Collaborative (GPHAC) Interviews

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Genomics and Population Health Action Collaborative (GPHAC) Interviews	Agency IC Tracking Number:	17IR

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
Other-WORD			GPHAC Questions for States.docx		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 %

	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

Title	Document	Date Uploaded
Emails	Emails to be sent to states.docx	01/11/2017
Request for Approval	GenIC_RequestforApproval_state_interviews..docx	01/11/2017

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