Information Collection

Aim 3 Telephone Questionnaire

IC 203732 under ICR 201309-0925-004 · OMB 0925-0669.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0669 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Aim 3 Telephone Questionnaire	Form and Instruction
1 Telephone Questionaire MSM_OMB_Attach_3_Telephone_Q_5_2012_V_2 0.doc	Form and Instruction

IC Title:

Aim 3 Telephone Questionnaire

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
Form and Instruction	1	Telephone Questionaire	MSM_OMB_Attach_3_Telephone_Q_5_2012_V_2 0.doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.