Information Collection

Interview Guide

IC 237208 under ICR 202507-0920-019 · OMB 0920-1274.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1274 Interview Guide	Form
Form 0920-1274 Communications Interview Guide Interview Guide	Form
0920-1274 Communications Interview Guide Attachment 2b. Data Collection Tool 2_Communications Interview Guide_0920-1274.docx	Form
0920-1274 Communications Interview Guide Attachment 2b. Data Collection Tool 2_Communications Interview Guide_0920-1274.docx	Form

IC Title:

Interview Guide

Agency IC Tracking Number:

0920-1274

Is this a Common Form? No

IC Status: Modified

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	0920-1274				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	30	0	30
Annual IC Time Burden (Hours)	15	0	15
Annual IC Cost Burden (Dollars)	0	-806	806

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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