Information Collection

Manager Consent and Interview - Intervention Visit 1

IC 228958 under ICR 201711-0920-008 · OMB 0920-1227.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1227 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Manager Consent and Interview - Intervention Visit 1	Form
Manager Consent and Interview Att 5 Mngr Infrmd Cnsnt and Intrvw Frm.docx	Form
Att 6 Manager Interview Marking Guide.docx Interview Marking Guide	IC Document

IC Title:

Manager Consent and Interview - Intervention Visit 1

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	none	Manager Consent and Interview	Att 5 Mngr Infrmd Cnsnt and Intrvw Frm.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54

Number of Respondents for Small Entity: 27

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Interview Marking Guide	Att 6 Manager Interview Marking Guide.docx	11/08/2017

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