Information Collection

Sample Screener

IC 43990 under ICR 200708-1850-006 · OMB 1850-0805.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Screener_SAQ_Child_rev.pdf	Other-child screener
Screener_SAQ_Twins_rev.pdf	Other-twin screener

IC Title:

Sample Screener

Agency IC Tracking Number:

3385

Is this a Common Form? No

IC Status: Modified

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
Other-child screener					No		Paper Only
Other-twin screener					No		Paper Only

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,722

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 30 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,722	-20,536	25,258
Annual IC Time Burden (Hours)	378	-13,392	13,770
Annual IC Cost Burden (Dollars)	0	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.

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