Telephone Follow-up

National Survey of Community-based Policy and Environmental Supports for Healthy Eating and Active Living

Documents and Forms

Document Name Document Type
Telephone Follow-up Form
Non-response Follow-up Appendix D4 Non Response Follow Up_12032013.doc Form
Appendix D5 Email Non Response Follow Up_12042013.doc D5 - Email Follow-up IC Document

Information Collection (IC) Details

IC Title:	Telephone Follow-up	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
Form	none	Non-response Follow-up	Appendix D4 Non Response Follow Up_12032013.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,484	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	22,420	22,420
Annual IC Time Burden (Hours)	1,868	1,868
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
D5 - Email Follow-up	Appendix D5 Email Non Response Follow Up_12042013.doc	12/04/2013

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