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Federal forms, ICRs, and supporting documents

Information Collection

Screening Telephone Call Script -- Part B (eligibles only)

IC 189526 under ICR 201308-0920-008 · OMB 0920-0743.

Documents and Forms
Document Name
Document Type
Other-WORD
IC Document
IC Document
Information Collection (IC) Details

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Screening Telephone Call Script -- Part B (eligibles only)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Appx G_Screening Telephone Call Script.docx Yes Yes Fillable Printable

Health Health Care Services

 

2,200 259
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   56 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,200 0 2,200 0 0 0
Annual IC Time Burden (Hours) 147 0 147 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Appx H-1 Invitation Cover Letter (paper letter) 7 30 2013 Appx H-1 Invitation Cover Letter (paper letter) 7 30 2013.docx 08/12/2013
Appx H-2 Invitation Cover Letter (email letter) 7 30 2013 Appx H-2 Invitation Cover Letter (email letter) 7 30 2013.docx 08/12/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.