Field Test Survey Instrument (Web and Telephone)

Field Test of Communication and Marketing Variables for Health Protection

Documents and Forms

Document Name Document Type
ATTACHMENT 3B WEB Field Test Survey Instrument.doc Other-Web Survey
ATTACHMENT 3A Telephone Field Test Survey Instrument.doc Other-Telephone Survey

Information Collection (IC) Details

IC Title:	Field Test Survey Instrument (Web and Telephone)	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-Web Survey			ATTACHMENT 3B WEB Field Test Survey Instrument.doc		Yes	Yes	Fillable Printable
Other-Telephone Survey			ATTACHMENT 3A Telephone Field Test Survey Instrument.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,932	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,932	1,932
Annual IC Time Burden (Hours)	580	580
Annual IC Cost Burden (Dollars)	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.