Information Collection

Grantee Interview

IC 215529 under ICR 201503-0920-005 · OMB 0920-1070.

Documents and Forms

Document Name Document Type
Grantee Interview Form and Instruction
Grantee Interview Guide Att 4 Grantee Interview Guide_3 02 2015.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Grantee Interview	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 and Instruction	none	Grantee Interview Guide	Att 4 Grantee Interview Guide_3 02 2015.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	18	18
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.