[OPHDST] Foundational User Interviews with the Public

[OS] CDC/ATSDR Formative Research and Tool Development

Documents and Forms

Document Name Document Type
Form 0920-1154 [OPHDST] Foundational User Interviews with the Public Form and Instruction
0920-1154 Foundational Screener (25AB) Att 1 Foundational.docx Form and Instruction
0920-1154 Foundational Data Collection Interview Scripts (25AB) Att 2 Foundational.docx Form and Instruction
SSA Foundational.docx SSA (25AB) IC Document
SSB Foundational.docx SSB (25AB) IC Document
0920-1154 Template Foundational.docx Template Foundational (25AB) IC Document
Att 3 Foundational.pdf Project Determination (25AB) IC Document

Information Collection (IC) Details

IC Title:	[OPHDST] Foundational User Interviews with the Public	Agency IC Tracking Number:	0920-1154-25AB

IC Status: Unchanged

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	0920-1154	Foundational Screener (25AB)	Att 1 Foundational.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Foundational Data Collection Interview Scripts (25AB)	Att 2 Foundational.docx		Yes	No	Fillable Fileable

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: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	65	65
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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