Information Collection

6-Month Followup

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

Documents and Forms

Document Name Document Type
Form 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

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	6-Month Followup	6-Month Followup	Attachment 2. CABHI_Client Follow-up Interview.doc		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 %

	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

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.