#3.Employer interview

Evaluation of Tribal Health Profession Opportunity Grants

Documents and Forms

Document Name Document Type
#3.Employer interview_Revised per OMB questions.doc Other-#3

Information Collection (IC) Details

IC Title:	#3.Employer interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-#3			#3.Employer interview_Revised per OMB questions.doc		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	52	0	52
Annual IC Time Burden (Hours)	39	0	39
Annual IC Cost Burden (Dollars)	0	-1,706	1,706

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.