Staff Interview

[NCHHSTP] Evaluation of Safe Spaces in CDC-directly funded Community-based Organizations (CBOs)

Documents and Forms

Document Name Document Type
Form 0920- Staff Interview Form and Instruction
0920- Staff Interviews Att 5_ Staff Interview.docx Form and Instruction
0920- Staff Interviews Att 5_ Staff Interview.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Staff Interview	Agency IC Tracking Number:	0920-22IJ

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-	Staff Interviews	Att 5_ Staff Interview.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	30	30
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.