Information Collection

Key Informant Interview Evaluator

IC 260625 under ICR 202507-0920-009 · OMB 0920-1412.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1412 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-23AA Key Informant Interview Evaluator	Form and Instruction
Form 0920-23AA Att. 4b Key Informant Interview Protocol - Evaluator Key Informant Interview Evaluator	Form and Instruction
Form 0920-1412 Key Informant Interview Protocol - Evaluator - 11JUL2025 Key Informant Interview Evaluator	Form and Instruction
0920-23AA Att. 4b Key Informant Interview Protocol - Evaluator Att. 4b Key Informant Interview Protocol - Evaluator.pdf	Form and Instruction
0920-23AA Att. 4b Key Informant Interview Protocol - Evaluator Att. 4b Key Informant Interview Protocol - Evaluator.pdf	Form and Instruction
0920-1412 Key Informant Interview Protocol - Evaluator - 11JUL2025 Att. 4b Key Informant Interview Protocol - Evaluator EO clean.docx	Form and Instruction
0920-1412 Key Informant Interview Protocol - Evaluator - 11JUL2025 Att. 4b Key Informant Interview Protocol - Evaluator EO clean.docx	Form and Instruction

IC Title:

Key Informant Interview Evaluator

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	0920-23AA				Yes	Yes	Fillable Fileable
Form and Instruction	0920-1412			N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	13	13
Annual IC Time Burden (Hours)	13	13
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.

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