Information Collection

Provider telephone script and recruitment information collection, including observations

IC 264185 under ICR 202405-0970-007 · OMB 0970-0625.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 3. Provider telephone script and recruitment information collection_with observations_12.20.23_clean.docx	Other-Recruitment
Instrument 3. Provider telephone script and recruitment information collection_with observations_12.20.23_clean.docx	Other-Recruitment

IC Title:

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
Other-Recruitment					Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	250	100	150
Annual IC Time Burden (Hours)	105	42	63
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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