Information Collection

Att 3t: Intercept Interview Guide

IC 225015 under ICR 202206-0920-015 · OMB 0920-1169.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 3t Intercept Interview Guide_reinstatement_07-15-20 (1).docx	Other-WORD
Att 3t Intercept Interview Guide_reinstatement_07-15-20 (1).docx	Other-WORD

IC Title:

Agency IC Tracking Number:

0920-21FV

Is this a Common Form? Yes

IC Status: Unchanged

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
Other-WORD					No		Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 657

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	Previously Approved
Annual Number of Responses for this IC	657	657
Annual IC Time Burden (Hours)	220	220
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.

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