Information Collection

Non-Respondent follow-up

IC 192722 under ICR 201004-0920-012 · OMB 0920-0862.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix H Telephone Follow-up Script.doc	Instruction
Appendix I Reminder Postcard.doc Appendix I Reminder Postcard	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
Instruction			Appendix H Telephone Follow-up Script.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 60

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	60	60
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix I Reminder Postcard	Appendix I Reminder Postcard.doc	04/05/2010

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