View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

[OPHDST] Foundational User Interviews with the Public 0920-1154-25AB
 
New
 
Voluntary
 

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

Health Illness Prevention

 

60 0
   
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 120 0 120 0 0 0
Annual IC Time Burden (Hours) 65 0 65 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA (25AB) SSA Foundational.docx 11/01/2024
SSB (25AB) SSB Foundational.docx 11/01/2024
Template Foundational (25AB) 0920-1154 Template Foundational.docx 11/01/2024
Project Determination (25AB) Att 3 Foundational.pdf 11/01/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.