Information Collection

In-Person Interview

IC 227427 under ICR 201707-0930-003 · OMB 0930-0380.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form In-Person Intervie In-Person Interview	Form and Instruction
In-Person Intervie In-Person Interview NMHS OMB_PDF 02.pdf	Form and Instruction
NMHS OMB_PDF 09.pdf In-Person Materials	IC Document

IC Title:

In-Person Interview

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	In-Person Interview	In-Person Interview	NMHS OMB_PDF 02.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	1,300	1,300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
In-Person Materials	NMHS OMB_PDF 09.pdf	07/10/2017

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