Information Collection

Qualitative Interviews

IC 222627 under ICR 201607-0930-002 · OMB 0930-0371.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Qualitative Interv Qualitative Interviews	Form and Instruction
Qualitative Interv Qualitative Interview Protocol 4__Attachment 4 - MHFA evaluation - Qualitative Interview Protocol.pdf	Form and Instruction
8__Attachment 8 - MHFA Evaluation consent form for interviews 2 24 16.pdf Qualitative Interview 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	Qualitative Interview Protocol	Qualitative Interview Protocol	4__Attachment 4 - MHFA evaluation - Qualitative Interview Protocol.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 23

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	23	23
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Qualitative Interview Consent Form	8__Attachment 8 - MHFA Evaluation consent form for interviews 2 24 16.pdf	07/26/2016

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