Information Collection

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

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0743 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appx G_Screening Telephone Call Script.docx	Other-WORD
Appx H-1 Invitation Cover Letter (paper letter) 7 30 2013.docx Appx H-1 Invitation Cover Letter (paper letter) 7 30 2013	IC Document
Appx H-2 Invitation Cover Letter (email letter) 7 30 2013.docx Appx H-2 Invitation Cover Letter (email letter) 7 30 2013	IC Document

IC Title:

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

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-WORD			Appx G_Screening Telephone Call Script.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,200

Number of Respondents for Small Entity: 259

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 56 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,200	2,200
Annual IC Time Burden (Hours)	147	147
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.