Information Collection

Telephone Script for Permission to be Contacted

IC 191057 under ICR 200910-0920-007 · OMB 0920-0838.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Telephone Script for Permission to be Contacted	Form
Telephone Script for Permission to be Contacted - Counse Attachment C1b 090309.doc	Form
Telephone Script for Permission to be Contacted - Counse Attachment C1a 090309.doc	Form

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	Telephone Script for Permission to be Contacted - Counselor is Study Coordinator	Attachment C1b 090309.doc		Yes	Yes	Fillable Fileable
Form	none	Telephone Script for Permission to be Contacted - Counselor is not Study Coordinator	Attachment C1a 090309.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 294

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	294	294
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
No associated records found

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