Information Collection

Follow Up Interview Guide

IC 205169 under ICR 201608-0930-001 · OMB 0930-0336.

Documents and Forms

Document Name Document Type
Form Follow Up Intervie Follow Up Interview Guide Form and Instruction
Follow Up Intervie Follow Up Interview Guide MAI-CoC Follow Up Interview Guide_042816.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Follow Up Interview Guide	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Follow Up Interview Guide	Follow Up Interview Guide	MAI-CoC Follow Up Interview Guide_042816.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 306	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	306	306
Annual IC Time Burden (Hours)	306	306
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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