Information Collection

Evaluator Interview

IC 208309 under ICR 201701-0930-003 · OMB 0930-0339.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SV Guide_Cost Ques Evaluator Interview	Form and Instruction
SV Guide_Cost Ques SV Guide_Cost Questionnaire Attachment 2_SV Guide_Cost Questionnaire.docx	Form and Instruction

IC Title:

Evaluator Interview

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	SV Guide_Cost Questionnaire	SV Guide_Cost Questionnaire	Attachment 2_SV Guide_Cost Questionnaire.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

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	Previously Approved
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	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.