Information Collection

MI/SP Caller Follow-up Consent Script Refusal

IC 207801 under ICR 201302-0930-001 · OMB 0930-0274.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0274 can be found here:

Documents and Forms

Document Name Document Type
Form Client Follow-up C MI/SP Caller Follow-up Consent Script Refusal Form and Instruction
Client Follow-up C Client Follow-up Consent Script Attachment B_Client Follow-up Consent Script.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	MI/SP Caller Follow-up Consent Script Refusal	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
Form and Instruction	Client Follow-up Consent Script	Client Follow-up Consent Script	Attachment B_Client Follow-up Consent Script.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	21	21
Annual IC Time Burden (Hours)	1	1
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.