Interviews

Assessment of Women’s Behavioral Health in Eastern Montana and Western North Dakota

Documents and Forms

Document Name Document Type
OWH_Draft KII Guide_081517.docx Other-guide interview
OWH_OMB KII Intro Letter_081517.docx interview IC Document

Information Collection (IC) Details

IC Title:	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
Other-guide interview			OWH_Draft KII Guide_081517.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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
interview	OWH_OMB KII Intro Letter_081517.docx	08/22/2017

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