Information Collection

[OPHDST] Foundational User Interviews with the Public

IC 272084 under ICR 202507-0920-010 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1154 Foundational Screener (25AB) [OPHDST] Foundational User Interviews with the Public	Form and Instruction
Form 0920-1154 Foundational Data Collection Interview Scripts (25AB) [OPHDST] Foundational User Interviews with the Public	Form and Instruction
0920-1154 Foundational Screener (25AB) Att 1 Foundational.docx	Form and Instruction
0920-1154 Foundational Data Collection Interview Scripts (25AB) Att 2 Foundational.docx	Form and Instruction
SSA Foundational.docx SSA (25AB)	IC Document
SSB Foundational.docx SSB (25AB)	IC Document
0920-1154 Template Foundational.docx Template Foundational (25AB)	IC Document
Att 3 Foundational.pdf Project Determination (25AB)	IC Document

IC Title:

[OPHDST] Foundational User Interviews with the Public

Agency IC Tracking Number:

0920-1154-25AB

IC Status: Unchanged

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	0920-1154				Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154				Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	65	65
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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

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