Information Collection

Telephone Follow-up

IC 209575 under ICR 201312-0920-003 · OMB 0920-1007.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Telephone Follow-up	Form
Non-response Follow-up Appendix D4 Non Response Follow Up_12032013.doc	Form
Appendix D5 Email Non Response Follow Up_12042013.doc D5 - Email Follow-up	IC Document

IC Title:

Telephone Follow-up

Agency IC Tracking Number:

Is this a Common Form? No

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	Non-response Follow-up	Appendix D4 Non Response Follow Up_12032013.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,484

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	22,420	22,420
Annual IC Time Burden (Hours)	1,868	1,868
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
D5 - Email Follow-up	Appendix D5 Email Non Response Follow Up_12042013.doc	12/04/2013

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