Information Collection

GPO Interview

IC 273020 under ICR 202412-0930-003 · OMB 0930-0402.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0402 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form GPO Interview Prot GPO Interview	Form and Instruction
GPO Interview Prot GPO Interview Protocol Attachment C GPO Interview Protocol.docx	Form and Instruction
GPO Interview Prot GPO Interview Protocol Attachment C GPO Interview Protocol.docx	Form and Instruction

IC Title:

GPO Interview

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
Form and Instruction	GPO Interview Protocol	GPO Interview Protocol	Attachment C GPO Interview Protocol.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: CCBHC-E

FR Citation: 75 FR 28264

Number of Respondents: 26

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	78	78
Annual IC Time Burden (Hours)	78	78
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.