Information Collection

Community Leaders or Service Providers

IC 247307 under ICR 202105-0920-002 · OMB 0920-1351.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1351 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-20PJ Community Leaders or Service Providers	Form and Instruction
0920-20PJ Interview Discussion Guide Attachment L_Interview_Discussion Guide for Community Leaders and Service Providers.docx	Form and Instruction
0920-20PJ Interview Discussion Guide Attachment L_Interview_Discussion Guide for Community Leaders and Service Providers.docx	Form and Instruction

IC Title:

Community Leaders or Service Providers

Agency IC Tracking Number:

0920-20PJ

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	0920-20PJ	Interview Discussion Guide	Attachment L_Interview_Discussion Guide for Community Leaders and Service Providers.docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12

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	12	12
Annual IC Time Burden (Hours)	24	24
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.