Information Collection

Outcome Follow-up Questionnaire in Person

IC 218389 under ICR 201509-0910-011 · OMB 0910-0808.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0808 can be found here:

Documents and Forms

Document Name Document Type
Attachment2_FollowUp_Instrument.docx Other-Follow Up

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Outcome Follow-up Questionnaire in Person	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
Other-Follow Up			Attachment2_FollowUp_Instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,364	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,364	2,364
Annual IC Time Burden (Hours)	1,578	1,578
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.