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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.