Information Collection

Follow-Up Telephone Interview

IC 225998 under ICR 201703-0920-002 · OMB 0920-1196.

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 Attachment D Follow-up Telephone Interview ENGLISH.March 2.CLEAN.docx	Form and Instruction
Follow-Up Telephone Interview - SPANISH Attachment D Follow-up telephone interview SPANISH March 2.CLEAN.docx	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	NA	Follow-Up Telephone Interview - ENGLISH	Attachment D Follow-up Telephone Interview ENGLISH.March 2.CLEAN.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Follow-Up Telephone Interview - SPANISH	Attachment D Follow-up 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: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	100	100
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.