Information Collection

6 month Followup

IC 195855 under ICR 201012-0930-002 · OMB 0930-0320.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0320 can be found here:

Documents and Forms

Document Name Document Type
Form Client Interview_6 6 month Followup Form
Client Interview_6 Client Interview_6Month 3 Attachment 3_Client Interview_6Month.3.3.11.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	6 month Followup	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	Client Interview_6Month	Client Interview_6Month	3 Attachment 3_Client Interview_6Month.3.3.11.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,708	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,708	4,708
Annual IC Time Burden (Hours)	1,883	1,883
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.