Information Collection

Qualitative Interview: Collaborative Process Evaluation (THRIVE Awardees)

IC 224635 under ICR 201801-0920-001 · OMB 0920-1178.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1178 can be found here:

Documents and Forms

Document Name Document Type
Attachment 5 Qualitative Interview Collaborative Process Evaluation 11 22 16 FINAL.docx Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Qualitative Interview: Collaborative Process Evaluation (THRIVE Awardees)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment 5 Qualitative Interview Collaborative Process Evaluation 11 22 16 FINAL.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	7	7
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	121	121

Documents for IC

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