Information Collection

Peer Recruiters - Recruiter Debriefing Form

IC 234908 under ICR 201902-0920-007 · OMB 0920-1262.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1262 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Peer Recruiters - Recruiter Debriefing Form	Form and Instruction
Reruiter Defriefing Form - English Att 7a_Recruiter Debriefing Form (English).docx	Form and Instruction
Recruiter Debriefing Form - Spanish Att 7b_Recruiter Debriefing Form (Spanish).docx	Form and Instruction

IC Title:

Peer Recruiters - Recruiter Debriefing Form

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	NA	Reruiter Defriefing Form - English	Att 7a_Recruiter Debriefing Form (English).docx	NA	No		Paper Only
Form and Instruction	NA	Recruiter Debriefing Form - Spanish	Att 7b_Recruiter Debriefing Form (Spanish).docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 900

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	900	900
Annual IC Time Burden (Hours)	30	30
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.