Information Collection

Interviews

IC 232276 under ICR 201805-2528-003 · OMB 2528-0321.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0321 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSDE Supporting Statement Appendix C 06-20-18.docx	Other-Interview Guide for Wellness D
SSDE Supporting Statement Appendix D 06-20-18.docx	Other-Interview Guide for Wellness N
SSDE Supporting Statement Appendix E 06-20-18.docx	Other-Interview Guide for Housing Pr
SSDE Supporting Statement Appendix F 06-20-18.docx	Other-Interview Guide for Service Co
SSDE Supporting Statement Appendix G 06-20-18.docx	Other-Interview Guide for Housing Pr

IC Title:

Interviews

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	Instrument File	Available Electronically?	Electronic Capability
Other-Interview Guide for Wellness Directors at Treatment Properties	SSDE Supporting Statement Appendix C 06-20-18.docx	No	Paper Only
Other-Interview Guide for Wellness Nurses at Treatment Properties	SSDE Supporting Statement Appendix D 06-20-18.docx	No	Paper Only
Other-Interview Guide for Housing Property Staff at Treatment Properties	SSDE Supporting Statement Appendix E 06-20-18.docx	No	Paper Only
Other-Interview Guide for Service Coordinators at Active Control Properties	SSDE Supporting Statement Appendix F 06-20-18.docx	No	Paper Only
Other-Interview Guide for Housing Property Staff at Active Control Properties	SSDE Supporting Statement Appendix G 06-20-18.docx	No	Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 220

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	220	220
Annual IC Time Burden (Hours)	550	550
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.