Information Collection

Interviews with Leadershp from WTC Clinical Centers of Excellence

IC 237330 under ICR 201907-0920-006 · OMB 0920-1280.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Interviews with Leadershp from WTC Clinical Centers of Excellence	Form and Instruction
WTCHP Impact Assessment and Strategic Planning In-depth Att D_Interview guide 2019-07-30.docx	Form and Instruction
WTCHP Brief Demographic Survey Att G_Brief Demo Survey_2019-07-26.pdf	Form and Instruction

IC Title:

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	n/a	WTCHP Brief Demographic Survey	Att G_Brief Demo Survey_2019-07-26.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	n/a	WTCHP Impact Assessment and Strategic Planning In-depth Interview Discussion Guide	Att D_Interview guide 2019-07-30.docx		No		Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3	3
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	240	240

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.