Information Collection

Final telephone screen

IC 46272 under ICR 201306-0990-003 · OMB 0990-0308.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0308 Appendix B.doc	Other-final telephone screen
0990-0308 Appendix C.doc	Other-survey
0990-0308 Appendix A.doc 0990-0308 Appendix A	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-final telephone screen			0990-0308 Appendix B.doc		No	No	Paper Only
Other-survey			0990-0308 Appendix C.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 167

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	167	-10	177
Annual IC Time Burden (Hours)	56	-3	59
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0990-0308 Appendix A	0990-0308 Appendix A.doc	06/27/2013

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