Questionnaire (Telephone Script)Private Sector

Information Collection of the Resources and Services Database of the National Prevention Information Network: 30 day

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0255 can be found here:

Documents and Forms

Document Name Document Type
Questionnaire (Telephone Script)Private Sector Form and Instruction
Appendix D. Telephone Script Questionnaire (Telephone Script).doc Form and Instruction
Questionnaire (Telephone Script).doc Telephone Script IC Document

Information Collection (IC) Details

IC Title:	Questionnaire (Telephone Script)Private Sector	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	None	Appendix D. Telephone Script	Questionnaire (Telephone Script).doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 125	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	125	125
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Telephone Script	Questionnaire (Telephone Script).doc

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