Information Collection

Postcard & telephone collection

IC 212714 under ICR 201408-2528-001 · OMB 2528-0302.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix II Call Script with Privacy.doc	Other-call script
Appendix III Field Script with Privacy.doc	Other-field script
Choice TO2 Appendices A B.docx	Other-postcard & flyer text

IC Title:

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	Instrument File	Available Electronically?	Electronic Capability
Other-call script	Appendix II Call Script with Privacy.doc	No	Paper Only
Other-field script	Appendix III Field Script with Privacy.doc	No	Paper Only
Other-postcard & flyer text	Choice TO2 Appendices A B.docx	No	Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,121

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,121	2,121
Annual IC Time Burden (Hours)	238	238
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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