Information Collection

NEARS Manager Interview

IC 221097 under ICR 202601-0920-006 · OMB 0920-0980.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NEARS Manager Interview	Form and Instruction
Manager Interview NEARS Manager Interview	Form and Instruction
Manager Interview Att7 NEARS Manager Interview Recording Form 11-25.docx	Form and Instruction
Manager Interview Att7 NEARS Manager Interview Recording Form 11-25.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

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 and Instruction	n/a				Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 46

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	1,104	-128	1,232
Annual IC Time Burden (Hours)	368	-43	411
Annual IC Cost Burden (Dollars)	0	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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