Information Collection

Crisis Center Call Log

IC 188784 under ICR 200904-0930-001 · OMB 0930-0301.

Documents and Forms

Document Name Document Type
Form Attachment A - Cal Crisis Center Call Log Form and Instruction
Attachment A - Cal Attachment A - Call Log Attachment A (Call Log).pdf Form and Instruction
Attachment B - Cal Attachment B - Call Log (Spanish version) Attachment B (Sp_Call Log) - spanish.pdf Form and Instruction
Attachment C (Cover letter) (2).doc Attachment C - Letter IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Crisis Center Call Log	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Attachment A - Call Log	Attachment A - Call Log	Attachment A (Call Log).pdf		Yes	Yes	Paper Only
Form and Instruction	Attachment B - Call Log (Spanish version)	Attachment B - Call Log (Spanish version)	Attachment B (Sp_Call Log) - spanish.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 27,490	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	54,840	54,840
Annual IC Time Burden (Hours)	4,108	4,108
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment C - Letter	Attachment C (Cover letter) (2).doc	04/02/2009

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.