Information Collection

Participants Follow-up Year 3 to 6

IC 199868 under ICR 201110-0925-002 · OMB 0925-0584.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0584 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Participants Follow-up Year 3 to 6	Form and Instruction
3 Interview Interview Form Contact Yr3_English.doc	Form and Instruction
4 Interview Interview Form Contact Yr4_English.doc	Form and Instruction
5 Interview Interview Form Contact Yr 5_English.doc	Form and Instruction
6 Interview Interview Form Contact Yr6_English.doc	Form and Instruction

IC Title:

Participants Follow-up Year 3 to 6

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3	Interview	Interview Form Contact Yr3_English.doc	Yes	Yes	Fillable Fileable
Form and Instruction	4	Interview	Interview Form Contact Yr4_English.doc	Yes	Yes	Fillable Fileable
Form and Instruction	5	Interview	Interview Form Contact Yr 5_English.doc	Yes	Yes	Fillable Fileable
Form and Instruction	6	Interview	Interview Form Contact Yr6_English.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9,334

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	9,334	9,334
Annual IC Time Burden (Hours)	2,334	2,334
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.