Information Collection

Screener- Recruiting Call and Consent

IC 181098 under ICR 200706-0920-003 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HMTS 7-06 Screener[1].doc	Instruction
HMTS 7-06 - Attachment X - Consent Form.doc HMTS 7-06 - Attachment X - Consent Form	IC Document
HMTS 7-06 Supporting Statement (May7-07).doc HMTS Justification	IC Document

IC Title:

Screener- Recruiting Call and Consent

Agency IC Tracking Number:

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
Instruction			HMTS 7-06 Screener[1].doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 252

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 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	252	0	0	0	0	0
Annual IC Time Burden (Hours)	21	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HMTS 7-06 - Attachment X - Consent Form	HMTS 7-06 - Attachment X - Consent Form.doc	05/18/2007
HMTS Justification	HMTS 7-06 Supporting Statement (May7-07).doc	07/25/2007

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