Information Collection

Partner Campus Representative

IC 234626 under ICR 201808-0990-003 · OMB 0990-0467.

Documents and Forms

Document Name Document Type
Attachment B_Campus Interview Guide.docx Other-guide
Attachment D_Invitation Letter_Campus Staff.docx invitation IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Partner Campus Representative	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-guide			Attachment B_Campus Interview Guide.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 36	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
invitation	Attachment D_Invitation Letter_Campus Staff.docx	12/21/2018

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