Information Collection

Follow-Up Telephone Interview

IC 221889 under ICR 201608-0920-008 · OMB 0920-1118.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Follow-Up Telephone Interview	Form and Instruction
Follow-Up Telephone Interview - ENGLISH 15AUG2016 Attachment D Follow-up Telephone Interview ENGLISH.Aug15.CLEAN.docx	Form and Instruction
Follow-Up Telephone Interview - SPANISH 15AUG2016 Attachment D Follow-up telephone interview Spanish Aug 15.CLEAN.docx	Form and Instruction

IC Title:

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
Form and Instruction	NA	Follow-Up Telephone Interview - ENGLISH 15AUG2016	Attachment D Follow-up Telephone Interview ENGLISH.Aug15.CLEAN.docx	NA	No		Paper Only
Form and Instruction	NA	Follow-Up Telephone Interview - SPANISH 15AUG2016	Attachment D Follow-up telephone interview Spanish Aug 15.CLEAN.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

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)	225	225
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.