Information Collection

Project Director - Phone Interview/web Survey

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Project Director - Phone Interview/web Survey	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	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 %

	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

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.