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Federal forms, ICRs, and supporting documents

Information Collection

Consent for qualitative interview– English (Att 5c)

IC 265787 under ICR 202503-0920-026 · OMB 0920-1402.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Consent for qualitative interview– English (Att 5c) 0902-1402
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1402 Attachment 5c SHIELD Model Qual Consent (English) Attachment 5c SHIELD Model Qual Consent (English).docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

50 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 50 0 0 0 0 50
Annual IC Time Burden (Hours) 4 0 0 0 0 4
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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