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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

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	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 %

table that charts list of burden
	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

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.