Information Collection

In-Depth Interview

IC 262656 under ICR 202403-0920-004 · OMB 0920-1421.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1421 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-24DF In-Depth Interview	Form
0920-24DF In-Depth Interview Consent English Att 5c_In-Depth Interview Consent English_Clean.docx	Form
0920-24DF In-Depth Interview Consent English Att 5c_In-Depth Interview Consent English_clean.docx	Form
0920-24DF In-Depth Interview Consent Spanish Att 5c_In-Depth Interview Consent Spanish_clean.docx	Form
0920-24DF In-Depth Interview Consent Spanish Att 5c_In-Depth Interview Consent Spanish_clean.docx	Form

IC Title:

In-Depth Interview

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form	0920-24DF	In-Depth Interview Consent English	Att 5c_In-Depth Interview Consent English_clean.docx		Yes	Yes	Fillable Fileable
Form	0920-24DF	In-Depth Interview Consent Spanish	Att 5c_In-Depth Interview Consent Spanish_clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 45

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	45	45
Annual IC Time Burden (Hours)	45	45
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.