Information Collection

Healthy Behavior Support Staff Site Visit Discussion Guide

IC 214154 under ICR 201412-0920-005 · OMB 0920-1068.

Documents and Forms

Document Name Document Type
Healthy Behavior Support Staff Site Visit Discussion Guide Form
Healthy Behavior Staff Discussion Guide Attachment E2 Discussion with Healthy Behavior Staff.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Healthy Behavior Support Staff Site Visit Discussion Guide	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	none	Healthy Behavior Staff Discussion Guide	Attachment E2 Discussion with Healthy Behavior Staff.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7	7
Annual IC Time Burden (Hours)	5	5
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.