Information Collection

DBHNA Follow-up

IC 197110 under ICR 201610-0930-003 · OMB 0930-0325.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Follow-Up Phone In DBHNA Follow-up	Form and Instruction
Follow-Up Phone In Follow-Up Phone Interview Guide Attachment A3 NAS 2013 Follow-Up Phone Interview Guide.docx	Form and Instruction

IC Title:

DBHNA Follow-up

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	Follow-Up Phone Interview Guide	Follow-Up Phone Interview Guide	Attachment A3 NAS 2013 Follow-Up Phone Interview Guide.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-50	50
Annual IC Time Burden (Hours)	-38	38
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.