Information Collection

Manager Consent and Interview - Intervention Visit 2

IC 228959 under ICR 201711-0920-008 · OMB 0920-1227.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1227 can be found here:

Documents and Forms

Document Name Document Type
Manager Consent and Interview - Intervention Visit 2 Form
Manager Consent and Interview Att 5 Mngr Infrmd Cnsnt and Intrvw Frm.docx Form
Att 6 Manager Interview Marking Guide.docx Interview Marking Guide IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Manager Consent and Interview - Intervention Visit 2	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	Manager Consent and Interview	Att 5 Mngr Infrmd Cnsnt and Intrvw Frm.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 27

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	54	54
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Interview Marking Guide	Att 6 Manager Interview Marking Guide.docx	11/08/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.