Information Collection

Questionnaire (Telephone Script)Private Sector

IC 178804 under ICR 200702-0920-005 · OMB 0920-0255.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.