Telephone Non-Response Follow-up Contact Script

Pilot Study of Community-Based Surveillance of Supports for Healthy Eating/Active Living (HE/AL)

Documents and Forms

Document Name Document Type
Appendix D4. Telephone Script Non Response Follow Up 01_19_12.doc Other-Telephone Script

Information Collection (IC) Details

IC Title:	Telephone Non-Response Follow-up Contact Script	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
Other-Telephone Script			Appendix D4. Telephone Script Non Response Follow Up 01_19_12.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	50	50
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.