Information Collection

6-Month Followup

IC 195855 under ICR 201705-0930-002 · OMB 0930-0320.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 6-Month Followup 6-Month Followup 6-Month Followup	Form and Instruction
6-Month Followup 6-Month Followup Attachment 2. CABHI_Client Follow-up Interview.doc	Form and Instruction

IC Title:

6-Month Followup

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	6-Month Followup				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,662

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
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,662	-46	4,708
Annual IC Time Burden (Hours)	2,331	448	1,883
Annual IC Cost Burden (Dollars)	0	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.

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