Information Collection

Att 16_CBA Key Informant Interview Script

IC 217967 under ICR 201902-0920-009 · OMB 0920-1099.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 16 InterviewScript.docx	Other-WORD
Att 15 InterviewEmail.docx Att15_CBA Key Informant Interview Email	IC Document

IC Title:

Agency IC Tracking Number:

15NR

Is this a Common Form? No

IC Status: Removed

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
Other-WORD					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-40	40
Annual IC Time Burden (Hours)	-10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att15_CBA Key Informant Interview Email		08/21/2015

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

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