Information Collection

Initial Telephone Interview

IC 225997 under ICR 201703-0920-002 · OMB 0920-1196.

Documents and Forms

Document Name Document Type
Initial Telephone Interview Form and Instruction
Initial Telephone Interview - ENGLISH Attachment C Initial telephone interview ENGLISH-March 2.CLEAN.docx Form and Instruction
Initial Telephone Interview - SPANISH Attachment C Initial telephone interview SPANISH.March 2.CLEAN.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Initial Telephone Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Initial Telephone Interview - ENGLISH	Attachment C Initial telephone interview ENGLISH-March 2.CLEAN.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Initial Telephone Interview - SPANISH	Attachment C Initial telephone interview SPANISH.March 2.CLEAN.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.