Information Collection

Post-Discharge Hospital Patients (Case Patients)- Telephone Interview

IC 205889 under ICR 201302-0920-016 · OMB 0920-0958.

Documents and Forms

Document Name Document Type
Attachment G - Telephone Interview Revised_4_01.04.2013_clean.docx Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Post-Discharge Hospital Patients (Case Patients)- Telephone Interview	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
Instruction			Attachment G - Telephone Interview Revised_4_01.04.2013_clean.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 95	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	95	95
Annual IC Time Burden (Hours)	32	32
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.