Recruitement Telephone Script

Anniston Community Health Survey: Follow up and Dioxin Analyses (ACHS-II)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0049 can be found here:

Documents and Forms

Document Name Document Type
Att3_3_RecruitmentTelephoneScript_091313.docx Other-WORD
Att3_1_InvitationLetter_091313.docx Att3_1_InvitationLetter_091313 IC Document

Information Collection (IC) Details

IC Title:	Recruitement Telephone Script	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
Other-WORD			Att3_3_RecruitmentTelephoneScript_091313.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: 09-19-0001 Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances	FR Citation: 53 FR 30720

Number of Respondents: 333	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	333	333
Annual IC Time Burden (Hours)	11	11
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att3_1_InvitationLetter_091313	Att3_1_InvitationLetter_091313.docx	10/30/2013

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