PRC Telephone Interview

Prevention Research Centers Program National Evaluation Reporting System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0650 can be found here:

Documents and Forms

Document Name Document Type
PRC Telephone Interview Form
Telephone Interview Attachment 5. Telephone Interview_2 13 2013.docx Form

Information Collection (IC) Details

IC Title:	PRC Telephone Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Telephone Interview	Attachment 5. Telephone Interview_2 13 2013.docx		No	No	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 37	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	37	0	37
Annual IC Time Burden (Hours)	19	-18	37
Annual IC Cost Burden (Dollars)	0	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.