Information Collection

CIS Telephone Clients - Demographic Questions (Appendix 1A)

IC 189802 under ICR 201208-0925-003 · OMB 0925-0208.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0208 can be found here:

Documents and Forms

Document Name Document Type
Form 2 CIS Telephone Clients - Demographic Questions (Appendix 1A) Form and Instruction
2 Telephone Clients - Demographic Questions Appendix 1A Telephone Questions.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CIS Telephone Clients - Demographic Questions (Appendix 1A)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	2	Telephone Clients - Demographic Questions	Appendix 1A Telephone Questions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD	FR Citation: 67 FR 60743

Number of Respondents: 24,300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	24,300	2,300	22,000
Annual IC Time Burden (Hours)	810	77	733
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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