Information Collection

Participants Call and Interview

IC 7272 under ICR 200712-0925-003 · OMB 0925-0334.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Participants Call and Interview	Form and Instruction
2 Interview Form ATT 8 - CHS Informant Interview form.pdf	Form and Instruction
3 CHS Call ATT 8 - Semi-annual Surveillance Call form.doc	Form and Instruction
1 Interview Script ATT 8 - CHS Informant Interview Script.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	Interview Form	ATT 8 - CHS Informant Interview form.pdf	Yes	Yes	Paper Only
Form and Instruction	3	CHS Call	ATT 8 - Semi-annual Surveillance Call form.doc	Yes	Yes	Paper Only
Form and Instruction	1	Interview Script	ATT 8 - CHS Informant Interview Script.doc	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 467

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	467	467
Annual IC Time Burden (Hours)	280	280
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.