Information Collection

Aim 2a Cohort Exit Interview (English/Spanish)

IC 263131 under ICR 202509-0920-006 · OMB 0920-1423.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1423 can be found here:

2026-01-30 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
Form 0920-22GA Aim 2a Cohort Exit Interview (English/Spanish) Form and Instruction
Form 0920-22GA Att 4m_Aim2a Cohort Exit Interview English Aim 2a Cohort Exit Interview (English/Spanish) Form and Instruction
Form 0920-22GA Att 4m_Aim2aCohortExitInterviewSpanish Aim 2a Cohort Exit Interview (English/Spanish) Form and Instruction
Form 0920-1423 Att 4m_Aim2a Cohort Exit Interview English _REV 19SEP2025 Aim 2a Cohort Exit Interview (English/Spanish) Form and Instruction
Form 0920-1423 Att 4m_Aim2a Cohort Exit Interview Spanish _REV 19SEP2025 Aim 2a Cohort Exit Interview (English/Spanish) Form and Instruction
0920-22GA Att 4m_Aim2a Cohort Exit Interview English Att_4m_Aim2aCohortExitInterviewEnglish[1].docx Form and Instruction
0920-22GA Att 4m_Aim2a Cohort Exit Interview English Att_4m_Aim2aCohortExitInterviewEnglish[1].docx Form and Instruction
0920-22GA Att 4m_Aim2aCohortExitInterviewSpanish Att_4m_Aim2aCohortExitInterviewSpanish[1].docx Form and Instruction
0920-22GA Att 4m_Aim2aCohortExitInterviewSpanish Att_4m_Aim2aCohortExitInterviewSpanish[1].docx Form and Instruction
0920-1423 Att 4m_Aim2a Cohort Exit Interview English _REV 19SEP202 Att 4m_ExitInterview_English_clean.docx Form and Instruction
0920-1423 Att 4m_Aim2a Cohort Exit Interview English _REV 19SEP202 Att 4m_ExitInterview_English_clean.docx Form and Instruction
0920-1423 Att 4m_Aim2a Cohort Exit Interview Spanish _REV 19SEP202 Att 4m_ExitInterview_Spanish_clean.docx Form and Instruction
0920-1423 Att 4m_Aim2a Cohort Exit Interview Spanish _REV 19SEP202 Att 4m_ExitInterview_Spanish_clean.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Aim 2a Cohort Exit Interview (English/Spanish)	Agency IC Tracking Number:	0920-22GA

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-22GA	Att 4m_Aim2a Cohort Exit Interview English	Att_4m_Aim2aCohortExitInterviewEnglish[1].docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-22GA	Att 4m_Aim2aCohortExitInterviewSpanish	Att_4m_Aim2aCohortExitInterviewSpanish[1].docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1423	Att 4m_Aim2a Cohort Exit Interview English _REV 19SEP2025	Att 4m_ExitInterview_English_clean.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1423	Att 4m_Aim2a Cohort Exit Interview Spanish _REV 19SEP2025	Att 4m_ExitInterview_Spanish_clean.docx	NA	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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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