Information Collection

Pilot Project Telephone Interview Guide

IC 213446 under ICR 201410-0925-003 · OMB 0925-0707.

Documents and Forms

Document Name Document Type
Form 5 PILOT PROJECT TELEPHONE INTERVIEW GUIDE Form
5 PILOT PROJECT TELEPHONE INTERVIEW GUIDE Attachment 5.Pilot Project Telephone Interview Guide.8-20-14.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PILOT PROJECT TELEPHONE INTERVIEW GUIDE	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	5	PILOT PROJECT TELEPHONE INTERVIEW GUIDE	Attachment 5.Pilot Project Telephone Interview Guide.8-20-14.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.