Information Collection

Community Partners Interview, State and Local Government Sector

IC 195054 under ICR 201010-0920-010 · OMB 0920-0876.

Documents and Forms

Document Name Document Type
Community Partners Interview, State and Local Government Sector Form
Att 9 - Interview Guide for Community Partners Attachment 9 Interview Guide for Community Partners.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Community Partners Interview, State and Local Government Sector	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	Att 9 - Interview Guide for Community Partners	Attachment 9 Interview Guide for Community Partners.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 72	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	72	72
Annual IC Time Burden (Hours)	72	72
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.