Information Collection

Project Director - Phone Interview/web Survey

IC 208305 under ICR 201701-0930-003 · OMB 0930-0339.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PD Interview Project Director - Phone Interview/web Survey	Form and Instruction
PD Interview PD Interview Attachment 1_PD Interview.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	PD Interview	PD Interview	Attachment 1_PD Interview.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 39

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	Previously Approved
Annual Number of Responses for this IC	39	-119	158
Annual IC Time Burden (Hours)	82	-250	332
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.