Telephone Interview with Service Providers

Evaluation of the Helen Keller National Center for Deaf-Blind Youths and Adults

Documents and Forms

Document Name Document Type
Telephone Interview with Service Providers Form and Instruction
Telephone Interview with Service Providers Att_Telephone Interview Service Providers 08-09.doc Form and Instruction
Att_Telephone Interview Service Providers 08-09.doc Letter of assurances IC Document

Information Collection (IC) Details

IC Title:	Telephone Interview with Service Providers	Agency IC Tracking Number:	4157

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	N/A	Telephone Interview with Service Providers	Att_Telephone Interview Service Providers 08-09.doc		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 40 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letter of assurances	Att_Telephone Interview Service Providers 08-09.doc	12/29/2009

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