Information Collection

Appendix F_FVL Instrument 3 MIECHV Lead Interview Guide

IC 267071 under ICR 202404-0906-006 · OMB 0906-0093.

Documents and Forms

Document Name Document Type
Form 3 Appendix F_FVL Instrument 3 MIECHV Lead Interview Guide Form and Instruction
3 MIECHV Lead Interview Guide Appendix F_FVL Instrument 3 MIECHV Lead Interview Guide.docx Form and Instruction
3 MIECHV Lead Interview Guide Appendix F_FVL Instrument 3 MIECHV Lead Interview Guide.docx Form and Instruction

Information Collection (IC) Details

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IC Title:	Appendix F_FVL Instrument 3 MIECHV Lead Interview Guide	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
Form and Instruction	3	MIECHV Lead Interview Guide	Appendix F_FVL Instrument 3 MIECHV Lead Interview Guide.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.