Information Collection

Follow-up III Telephone Prompting Script

IC 220199 under ICR 201602-0925-013 · OMB 0925-0522.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Follow-up III Telephone Prompting Script	Form and Instruction
3 Follow-Up Phone script SISOMB2016ATTACHMENT2cFOLLOWUPscript20160219REVISED.pdf	Form and Instruction

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3	Follow-Up Phone script	SISOMB2016ATTACHMENT2cFOLLOWUPscript20160219REVISED.pdf		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,832

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	4,832	4,832
Annual IC Time Burden (Hours)	242	242
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.