Information Collection

Interviews with Wellness Nurses

IC 259308 under ICR 202302-2528-001 · OMB 2528-0321.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0321 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Final - Apendixes.docx	Other-Interviews with Wellness Nurse
Final - Apendixes.docx	Other-Interviews with Wellness Nurse

IC Title:

Interviews with Wellness Nurses

Agency IC Tracking Number:

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
Other-Interviews with Wellness Nurses			Final - Apendixes.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 44

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	44	44
Annual IC Time Burden (Hours)	132	132
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.