Information Collection

Interview

IC 235196 under ICR 201902-0920-019 · OMB 0920-1266.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1266 can be found here:

Documents and Forms

Document Name Document Type
Interview Form and Instruction
ChiCAS Interview - English 05JUN2019 Att 4e_ChiCAS Interview English_03Oct2018.docx Form and Instruction
ChiCAS Interview - Spanish 05JUN2019 Att 4f_ChiCAS Interview Spanish_03Oct2018.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	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	NA	ChiCAS Interview - English 05JUN2019	Att 4e_ChiCAS Interview English_03Oct2018.docx	NA	No		Paper Only
Form and Instruction	NA	ChiCAS Interview - Spanish 05JUN2019	Att 4f_ChiCAS Interview Spanish_03Oct2018.doc	NA	No		Paper Only

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	23	23
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.