Instrument 5_Listening visit topic guide for community outreach and partner staff

Title X Implementation Study

Documents and Forms

Document Name Document Type
Instrument 5_Listening visit topic guide for community outreach and partner staff.docx Other-Listening visit topic guide
Instrument 5_Listening visit topic guide for community outreach and partner staff.docx Other-Listening visit topic guide

Information Collection (IC) Details

IC Title:	Instrument 5_Listening visit topic guide for community outreach and partner staff	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-Listening visit topic guide			Instrument 5_Listening visit topic guide for community outreach and partner staff.docx		No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 27	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	27	27
Annual IC Time Burden (Hours)	20	20
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.