Information Collection

CPHP Customer/Partner Follow-up Interview Instrument

IC 190131 under ICR 200907-0920-004 · OMB 0920-0826.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Customer/Partner Follow-up Survery Instrument CPHP Customer/Partner Follow-up Interview Instrument	Form
Customer/Partner Follow-up Survery Instrument Attachment E_Customer-Partner Follow-Up Interview Instrument.CDC FINAL.doc	Form
Attachment G_E-mail follow-up.doc Email Follow-up to Customer/Partner Survey	IC Document
Attachment H_Telephone follow-up.doc Telephone Follow-up to Customer Survey	IC Document

IC Title:

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	none				No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	20	20
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Email Follow-up to Customer/Partner Survey		07/13/2009
Telephone Follow-up to Customer Survey		07/13/2009

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

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