Information Collection

Employer Phone Interview Guide

IC 202672 under ICR 201206-0920-002 · OMB 0920-0965.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0965 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att D-2_NHWP_ErPhIntervGude.pdf	Other-WORD
Att D-1_ErEligReq.pdf Att D-1_ErEligReq	IC Document
Att D-3_NHWP_ErIntervInst.pdf Att D-3_ErIntervInst	IC Document

IC Title:

Employer Phone Interview Guide

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Att D-2_NHWP_ErPhIntervGude.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 69

Number of Respondents for Small Entity: 21

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	69	69
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att D-1_ErEligReq	Att D-1_ErEligReq.pdf	06/04/2012
Att D-3_ErIntervInst	Att D-3_NHWP_ErIntervInst.pdf	06/04/2012

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