Information Collection

Review of materials prior to BOTH preliminary and follow-up interviews

IC 241352 under ICR 202004-0935-003 · OMB 0935-0251.

Documents and Forms

Document Name Document Type
Form 4 Review of materials prior to BOTH preliminary and follow-up interviews Form and Instruction
4 Review of materials prior to BOTH preliminary and follow Attachment F.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Review of materials prior to BOTH preliminary and follow-up interviews	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	4	Review of materials prior to BOTH preliminary and follow-up interviews â LHS leaders/decisionmakers	Attachment F.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 33	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	66	66
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.