Information Collection

Participant Components Pre-Exam Telephone contact for appointment

IC 221019 under ICR 201604-0925-002 · OMB 0925-0216.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Participant Components Pre-Exam Telephone contact for appointment	Form and Instruction
3 Attachment 6 Exam Scheduling Attach 6 Exam Scheduling .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	Attachment 6 Exam Scheduling	Attach 6 Exam Scheduling .pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,450

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	1,450	1,450
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.