Information Collection

Initial Telephone Contact and PDI Discussion Guide

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Initial Telephone Contact and PDI Discussion Guide	Agency IC Tracking Number:

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	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 %

	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

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.