Information Collection

Member Checking (Validation) Session Interview Guide

IC 251285 under ICR 202201-0920-014 · OMB 0920-1374.

Documents and Forms

Document Name Document Type
Form 0920 Member Checking (Validation) Session Interview Guide Form and Instruction
0920 Member Checking (Validation) Session Interview Guide Att. E Member Checking Session.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Member Checking (Validation) Session Interview Guide	Agency IC Tracking Number:	0920-21IE

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	0920	Member Checking (Validation) Session Interview Guide	Att. E Member Checking Session.docx		No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 17	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	17	17
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.