Information Collection

Interactive Voice Response Survey

IC 210763 under ICR 201311-0920-012 · OMB 0920-1003.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Interactive Voice Response Survey	Form
Survey - Spanish CDC-INFO IVR survey attachmentC_final.docx	Form
Survey - English CDC-INFO IVR survey attachmentB_final.doc	Form
Generic Clearance Submission Template.docx GenIC Request	IC Document
attachmentA.docx Background Information	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

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	none	Survey - Spanish	CDC-INFO IVR survey attachmentC_final.docx		Yes	Yes	Fillable Fileable
Form	none	Survey - English	CDC-INFO IVR survey attachmentB_final.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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	60,000	0	0	0	0	0
Annual IC Time Burden (Hours)	4,000	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request	Generic Clearance Submission Template.docx	03/18/2014
Background Information	attachmentA.docx	03/18/2014

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