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Federal forms, ICRs, and supporting documents

Information Collection

Interview Questionnaire

IC 180565 under ICR 202503-0920-027 · OMB 0920-0740.

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Information Collection (IC) Details

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Interview Questionnaire 0920-0740-25-0058
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none 2024 Programming Questionnaire - English Att 5a MMP 2024-2026 Questionnaire English.pdf Yes Yes Fillable Fileable
Form 0920-25-0058 MMP Questionnaire Att 1b_2024 EN MMP Paper Questionnaire v24.2_Clean.pdf Yes Yes Fillable Fileable
Form 0920-25-0058 MMP Questionnaire _SPANISH Att 1d_2024 SP MMP Paper Questionnaire v24.2_Clean.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

7,760 7,520
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 7,760 0 0 0 0 7,760
Annual IC Time Burden (Hours) 5,173 0 0 0 0 5,173
Annual IC Cost Burden (Dollars) 134,015 0 0 0 0 134,015

Title Document Date Uploaded
2024 Programming Questionnaire - Spanish Att 5b MMP 2024-2026 Questionnaire Spanish.pdf 04/10/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.