Information Collection

Initial Telephone Contact and PDI Discussion Guide

IC 192913 under ICR 201005-0925-008 · OMB 0925-0617.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Initial Telephone Contact and PDI Discussion Guide	Form
1 Initial telephone interview Attachment 6_Telephone Script.docx	Form
2 Survey Attachment 2_PDI Discussion Guide.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	2	Survey	Attachment 2_PDI Discussion Guide.doc		Yes	Yes	Paper Only
Form	1	Initial telephone interview	Attachment 6_Telephone Script.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 408

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	408	408
Annual IC Time Burden (Hours)	84	84
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.