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Telephone Interview Script
Health Insurance Plans Research Study
OMB: 0920-1079
IC ID: 215721
OMB.report
HHS/CDC
OMB 0920-1079
ICR 201503-0920-007
IC 215721
( )
Documents and Forms
Document Name
Document Type
Telephone Interview Script
Form
Sample Interview Questions
Appendix E_Sample Interview Questions_030215.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Telephone Interview Script
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
Sample Interview Questions
Appendix E_Sample Interview Questions_030215.docx
Yes
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
9
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
9
0
9
0
0
0
Annual IC Time Burden (Hours)
9
0
9
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
