Telephone Interview

Assessment of the Cancer Survivorship Demonstration Project

Documents and Forms

Document Name Document Type
Att 4_Interview Guide.docx Other-Interview Guide
Att 4a_Introductory Email for Interviewees.docx Introductory Email IC Document
Att 4b_ Follow-up Email for Interviewees.docx Reminder Email IC Document
Att 4c_Second Follow-up Email for Interviewees.docx Follow-up Email IC Document
Att 4d_Thank you Email for Interviewees.docx Thank you Email IC Document

Information Collection (IC) Details

IC Title:	Telephone Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-Interview Guide			Att 4_Interview Guide.docx		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8	8
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	355	355

Documents for IC

Title	Document	Date Uploaded
Introductory Email	Att 4a_Introductory Email for Interviewees.docx	11/01/2018
Reminder Email	Att 4b_ Follow-up Email for Interviewees.docx	11/01/2018
Follow-up Email	Att 4c_Second Follow-up Email for Interviewees.docx	11/01/2018
Thank you Email	Att 4d_Thank you Email for Interviewees.docx	11/01/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.