Information Collection

SPARCCS Follow-Up

IC 186879 under ICR 200810-0925-003 · OMB 0925-0595.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5 SPARCCS Follow-Up	Form and Instruction
5 Follow-Up Contacts Attachment 10 Follow up Phone Scripts_8 July 2008.doc	Form and Instruction

IC Title:

SPARCCS Follow-Up

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	5	Follow-Up Contacts	Attachment 10 Follow up Phone Scripts_8 July 2008.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,103

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	4,412	4,412
Annual IC Time Burden (Hours)	368	368
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.