Instrument 3: LIA Interview Protocol

Family Level Assessment and State of Home Visiting (FLASH-V) Outreach and Recruitment Study

Documents and Forms

Document Name Document Type
Instrument 3_LIA Interview Protocol.docx Other-LIA Interview Protocol
Instrument 3_LIA Interview Protocol_REVISED_1.15.21_CLEAN.docx Other-LIA Interview Protocol

Information Collection (IC) Details

IC Title:	Instrument 3: LIA Interview Protocol	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
Other-LIA Interview Protocol			Instrument 3_LIA Interview Protocol_REVISED_1.15.21_CLEAN.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	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	60	60
Annual IC Time Burden (Hours)	45	45
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.