Information Collection

Ex Assessment CCL Recipient Interview Guide_WW (Attachment 4k)

IC 271848 under ICR 202410-0920-005 · OMB 0920-1453.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1453 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-24FI Ex Assessment CCL Recipient Interview Guide_WW (Attachment 4k) Form and Instruction
0920-24FI In-Depth Assessment – Exploratory Assessment Recipient I Att 4k. Ex Assessment_CCL_Recipient_Interview Guide_WW.docx Form and Instruction
0920-24FI In-Depth Assessment – Exploratory Assessment Recipient I Att 4k. Ex Assessment_CCL_Recipient_Interview Guide_WW.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Ex Assessment CCL Recipient Interview Guide_WW (Attachment 4k)	Agency IC Tracking Number:	0920-24FI

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	0920-24FI	In-Depth Assessment â Exploratory Assessment Recipient Interview Guide â Community Clinical Links â WISEWOMAN	Att 4k. Ex Assessment_CCL_Recipient_Interview Guide_WW.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2	2
Annual IC Time Burden (Hours)	3	3
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.