Information Collection

Follow-up Interview Guide

IC 217705 under ICR 201511-0920-003 · OMB 0920-1005.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1005 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment D2 Follow Up Interviewer Guide_1005 OlderAdult Final.docx	Other-WORD
Attachment C3b_follow-up Letter.docx Correspondence	IC Document

IC Title:

Follow-up Interview Guide

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-WORD			Attachment D2 Follow Up Interviewer Guide_1005 OlderAdult Final.docx		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0160 Records of Subjects in Health Promotion and Education Studies

FR Citation: 51 FR 42484

Number of Respondents: 900

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	Previously Approved
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Correspondence	Attachment C3b_follow-up Letter.docx	07/30/2015

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