Information Collection

Flu on CallTM National Network of Telephone Triage Lines Demonstration Pilot

IC 219405 under ICR 201407-0920-001 · OMB 0920-1026.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A_United Way 211 Information Specialist Intake Screen_Flu OnCall.jpg	Instruction
Attachment B_Management Guidelines for Adults (≥18 years) or Children (2-17 years) with Possible Influenza-Like Illness.docx	Instruction
0920-1026_GenIC_Demonstration Pilot_ Flu On Call TM_National Network of Telephone Triage Lines _Final ICRO 12 23 2015.docx GenIC Request	IC Document

IC Title:

Agency IC Tracking Number:

16HQ

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
Instruction				NA	Yes	Yes	Fillable Fileable
Instruction				NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,500

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 Agency Discretion
Annual Number of Responses for this IC	4,500	4,500
Annual IC Time Burden (Hours)	195	195
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request		12/23/2015

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

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