Information Collection

Grantee Interview

IC 241788 under ICR 202602-0930-002 · OMB 0930-0377.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Grantee-Level Inte Grantee-Level Interview Grantee Interview	Form and Instruction
Grantee-Level Inte Grantee-Level Interview Attachment 4 SPF Rx Grantee-Level Interview_2025_final.docx	Form and Instruction

IC Title:

Grantee Interview

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	Grantee-Level Interview				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 26

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	26	13	13
Annual IC Time Burden (Hours)	39	20	19
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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