Information Collection

Telephone Follow-Up Survey

IC 226839 under ICR 201704-0920-006 · OMB 0920-1183.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Telephone Follow-Up Survey	Form and Instruction
ZPER Telephone Follow-Up Survey - English Att 9a Telephone Follow-up Survey _English_final.docx	Form and Instruction
ZPER Telephone Follow-Up Survey - Spanish Att 9b Telephone Follow-up Survey _Spanish_final.docx	Form and Instruction
ZPER Telephone Follow-Up Survey - English Phone Format Att 9c ZPER Telephone Follow Up_English_Phone Format_050217.docx	Form and Instruction
ZPER Telephone Follow-Up Survey - English Phone Format Att 9d ZPER Telephone Follow Up_Spanish_Phone Format_050217.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?	Electronic Capability
Form and Instruction	NA	ZPER Telephone Follow-Up Survey - English Phone Format	Att 9d ZPER Telephone Follow Up_Spanish_Phone Format_050217.docx	NA	No	Paper Only
Form and Instruction	NA	ZPER Telephone Follow-Up Survey - English Phone Format	Att 9c ZPER Telephone Follow Up_English_Phone Format_050217.docx	NA	No	Paper Only
Form and Instruction	NA	ZPER Telephone Follow-Up Survey - English	Att 9a Telephone Follow-up Survey _English_final.docx	NA	No	Paper Only
Form and Instruction	NA	ZPER Telephone Follow-Up Survey - Spanish	Att 9b Telephone Follow-up Survey _Spanish_final.docx	NA	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0136 - Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 3,070

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,070	3,070
Annual IC Time Burden (Hours)	768	768
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.