Information Collection

Employer Phone Interview Guide

IC 202672 under ICR 201303-0920-012 · OMB 0920-0965.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment_D-2_NHWP_Employer_Phone_Interview_Guide.docx	Other-null
Attachment_D-3_Employer_Interviewer_Instructions.docx Attachment_D-3_Employer_Interviewer_Instructions	IC Document
Attachment_D-1_NHWP Eligibility Requirements.docx Attachment_D-1_NHWP Eligibility Requirements	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-null			Attachment_D-2_NHWP_Employer_Phone_Interview_Guide.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

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
	Approved	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
Attachment_D-3_Employer_Interviewer_Instructions	Attachment_D-3_Employer_Interviewer_Instructions.docx	03/26/2013
Attachment_D-1_NHWP Eligibility Requirements	Attachment_D-1_NHWP Eligibility Requirements.docx	03/26/2013

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