Information Collection

NCAAM Clearinghouse Telephone Survey

IC 206331 under ICR 201112-0925-001 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NCAAM Clearinghouse Telephone Survey	Form and Instruction
1 NCAAM Clearinghouse Telephone Survey APPENDIX A Survey Instrument- rev 4.1.2013.doc	Form and Instruction
Fast track Template_NCCAM phone survey 2013_FINAL[2].doc Fast Track Template	IC Document
Appendix B Caller Anonymity.doc Appendix B Caller Anonymity	IC Document

IC Title:

NCAAM Clearinghouse Telephone Survey

Agency IC Tracking Number:

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 and Instruction	1	NCAAM Clearinghouse Telephone Survey	APPENDIX A Survey Instrument- rev 4.1.2013.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 275

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 New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	275	0	0	0	0	0
Annual IC Time Burden (Hours)	23	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Template	Fast track Template_NCCAM phone survey 2013_FINAL[2].doc	04/01/2013
Appendix B Caller Anonymity	Appendix B Caller Anonymity.doc	04/01/2013

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