Information Collection

Parent Telephone Screening Script

IC 210510 under ICR 201402-0935-001 · OMB 0935-0190.

Documents and Forms

Document Name Document Type
Form 11 Parent Telephone Screening Script Form and Instruction
11 Parent Telephone Screening Script Attachment M- 2014 Parent Telephone Screening Script.docx Form and Instruction
Attachment L- 2014 Parent Focus Group Recruitment Materials.docx Attachment L- 2014 Parent Focus Group Recruitment Materials IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Parent Telephone Screening Script	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	11	Parent Telephone Screening Script	Attachment M- 2014 Parent Telephone Screening Script.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 229	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	229	229
Annual IC Time Burden (Hours)	19	19
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment L- 2014 Parent Focus Group Recruitment Materials	Attachment L- 2014 Parent Focus Group Recruitment Materials.docx	02/19/2014

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