Information Collection

Multimedia Screener - Spanish and English

IC 46123 under ICR 200611-0596-002 · OMB 0596-0203.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Multimedia Screener - Spanish and English	Form
Multimedia Screener - English Appendix A2 - Revised 8-25-06 Multimedia Screener .doc	Form
Multimedia Screener - Spanish Appendix A1 - Revised 8-25-06 Multimedia Screener Spanish.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Form	None	Multimedia Screener - English	Appendix A2 - Revised 8-25-06 Multimedia Screener .doc		No		Paper Only
Form	None	Multimedia Screener - Spanish	Appendix A1 - Revised 8-25-06 Multimedia Screener Spanish.doc		No		Paper Only

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,400	1,400
Annual IC Time Burden (Hours)	117	117
Annual IC Cost Burden (Dollars)	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.