Information Collection

Telephone Follow-Up Survey (New Version)

IC 229601 under ICR 201712-0920-013 · OMB 0920-1199.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1199 Telephone Follow-Up Survey (New Version)	Form and Instruction
0920-1199 ZPER Telephone Follow-Up Questionnaire - English Att 9a Telephone Follow-up Survey_English_OMB change request_122117_clean.docx	Form and Instruction
0920-1199 ZPER Telephone Follow-Up Questionnaire - Spanish Att 9b Telephone Follow-up Survey_Spanish_122118_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	0920-1199	ZPER Telephone Follow-Up Questionnaire - English	Att 9a Telephone Follow-up Survey_English_OMB change request_122117_clean.docx	NA	No		Paper Only
Form and Instruction	0920-1199	ZPER Telephone Follow-Up Questionnaire - Spanish	Att 9b Telephone Follow-up Survey_Spanish_122118_clean.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: 1,520

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	1,520	1,520
Annual IC Time Burden (Hours)	304	304
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.