Information Collection

Telephone Recruitment and Screening

IC 207189 under ICR 201401-0920-004 · OMB 0920-0982.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Telephone Recruitment and Screening	Form and Instruction
4a - Telephone recruitment and screening Att 4A_Telephone Recruitment and Screening Script_01082014.docx	Form and Instruction
Att 4B_Cover Letter-Those who cannot be reached by phone_01082014.docx 4b - Cover letter for those not reached by phone	IC Document
Att 4C_Cover Letter-Phone Recruits_01082014.docx 4c - Cover letter for phone recruits	IC Document
Att 4D_Study Fact Sheet_01082014.docx 4d - Fact sheet	IC Document

IC Title:

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	none	4a - Telephone recruitment and screening	Att 4A_Telephone Recruitment and Screening Script_01082014.docx		No	No	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: 09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 252

Number of Respondents: 225

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	Previously Approved
Annual Number of Responses for this IC	225	225
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
4b - Cover letter for those not reached by phone	Att 4B_Cover Letter-Those who cannot be reached by phone_01082014.docx	01/08/2014
4c - Cover letter for phone recruits	Att 4C_Cover Letter-Phone Recruits_01082014.docx	01/08/2014
4d - Fact sheet	Att 4D_Study Fact Sheet_01082014.docx	01/08/2014

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