Information Collection

Key Informants Interview

IC 216726 under ICR 201505-0920-005 · OMB 0920-1019.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1019 can be found here:

Documents and Forms

Document Name Document Type
Key Informants Interview Form
Interviewer Data Collection Worksheet Att 10a_Interviewer Data Collection Worksheet.docx Form
Revised Key Informant Interview Script Att 10b_Key Informant Interview Script_OMB comments_KB_clean copy.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Key Informants 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	none	Interviewer Data Collection Worksheet	Att 10a_Interviewer Data Collection Worksheet.docx		No		Paper Only
Form	none	Revised Key Informant Interview Script	Att 10b_Key Informant Interview Script_OMB comments_KB_clean copy.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	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	120	120
Annual IC Time Burden (Hours)	60	60
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.