Information Collection

Eligibility Screening for Pretest and Main Study

IC 181528 under ICR 200708-0920-001 · OMB 0920-0761.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0761 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Eligibility Screening for Pretest and Main Study	Form and Instruction
Eligibility Script for Pretest and Main Study Attachment G Eligibility Script for Pretest & Main.doc	Form and Instruction

IC Title:

Eligibility Screening for Pretest and Main Study

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 and Instruction	None	Eligibility Script for Pretest and Main Study	Attachment G Eligibility Script for Pretest & Main.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 0920-0136 Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 1,603

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	1,603	1,603
Annual IC Time Burden (Hours)	27	27
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.