Information Collection

Follow-Up Telephone Interview

IC 221889 under ICR 201608-0920-008 · OMB 0920-1118.

Documents and Forms

Document Name Document Type
Follow-Up Telephone Interview Form and Instruction
Follow-Up Telephone Interview - ENGLISH 15AUG2016 Attachment D Follow-up Telephone Interview ENGLISH.Aug15.CLEAN.docx Form and Instruction
Follow-Up Telephone Interview - SPANISH 15AUG2016 Attachment D Follow-up telephone interview Spanish Aug 15.CLEAN.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Follow-Up Telephone 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
Form and Instruction	NA	Follow-Up Telephone Interview - ENGLISH 15AUG2016	Attachment D Follow-up Telephone Interview ENGLISH.Aug15.CLEAN.docx	NA	No		Paper Only
Form and Instruction	NA	Follow-Up Telephone Interview - SPANISH 15AUG2016	Attachment D Follow-up telephone interview Spanish Aug 15.CLEAN.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 900	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	225	225
Annual IC Cost Burden (Dollars)	0	0

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.