Information Collection

Participant Telephone Interviews

IC 182192 under ICR 200901-0925-003 · OMB 0925-0584.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0584 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Participant Telephone Interviews Form and Instruction
1 Recall Diet and Supplement Phone Script recall.doc Form and Instruction
3 Informant Informant Phone Script_Follow-up.doc Form and Instruction
2 survey Annual Followup_Y1_11-03-08annotated.doc Form and Instruction
5 survey Annual Followup_Y2_11-03-08annotated.doc Form and Instruction
6 survey Annual Followup_Y3_11-03-08annotated.doc Form and Instruction
4 survey Informant interview_10-20-08annotated.doc Form and Instruction
7 survey Exit Interview_10-24-08.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Participant Telephone Interviews	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Recall	Diet and Supplement Phone Script recall.doc	Yes	Yes	Paper Only
Form and Instruction	3	Informant	Informant Phone Script_Follow-up.doc	Yes	Yes	Paper Only
Form and Instruction	2	survey	Annual Followup_Y1_11-03-08annotated.doc	Yes	Yes	Paper Only
Form and Instruction	5	survey	Annual Followup_Y2_11-03-08annotated.doc	Yes	Yes	Paper Only
Form and Instruction	6	survey	Annual Followup_Y3_11-03-08annotated.doc	Yes	Yes	Paper Only
Form and Instruction	4	survey	Informant interview_10-20-08annotated.doc	Yes	Yes	Paper Only
Form and Instruction	7	survey	Exit Interview_10-24-08.doc	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,333	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	5,333	5,333
Annual IC Time Burden (Hours)	3,573	3,573
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.