Information Collection

Att D_Phone Script

IC 221652 under ICR 201605-0920-014 · OMB 0920-1119.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att D - Phone Script 4Apr16.docx	Other-WORD

IC Title:

Att D_Phone Script

Agency IC Tracking Number:

15BCU

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
Other-WORD			Att D - Phone Script 4Apr16.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0167 Health Resources Utilization Statistics

FR Citation: 49 FR 37697

Number of Respondents: 912

Number of Respondents for Small Entity: 128

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 4 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	912	912
Annual IC Time Burden (Hours)	76	76
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.