Information Collection

Project Director Interview

IC 210019 under ICR 201701-0930-003 · OMB 0930-0339.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Discussion Guide_C Project Director Interview	Form and Instruction
Discussion Guide_C Discussion Guide_Cost Questionnaire Attachment 02_SV Discussion Guide_Cost Questionnaire.docx	Form and Instruction
Attachment 06 and 07_Staff and Client SiteVisit Consent.docx Staff and Client SiteVisit Consent	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	Discussion Guide_Cost Questionnaire	Discussion Guide_Cost Questionnaire	Attachment 02_SV Discussion Guide_Cost Questionnaire.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

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
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-250	250
Annual IC Time Burden (Hours)	-500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Staff and Client SiteVisit Consent	Attachment 06 and 07_Staff and Client SiteVisit Consent.docx	01/13/2014

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