Information Collection

Recruitment Contact and Appoinment Confirmation

IC 182188 under ICR 200709-0925-003 · OMB 0925-0584.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0584 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Recruitment Contact and Appoinment Confirmation	Form and Instruction
1 In Person Script In-person Script.doc	Form and Instruction
2 Residential Response Resident Response.doc	Form and Instruction
3 App. Reminder Call Appt Reminder call_09-12-07.doc	Form and Instruction
4 Phone Script Phone Script.doc	Form and Instruction
5 Safety Screen Visit prep and safety screen_OMB.doc	Form and Instruction
Brochure-Eng.pdf Brochure-Eng	IC Document
introductory letter.doc introductory letter	IC Document

IC Title:

Recruitment Contact and Appoinment Confirmation

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	In Person Script	In-person Script.doc	Yes	Yes	Paper Only
Form and Instruction	2	Residential Response	Resident Response.doc	Yes	Yes	Paper Only
Form and Instruction	3	App. Reminder Call	Appt Reminder call_09-12-07.doc	Yes	Yes	Paper Only
Form and Instruction	4	Phone Script	Phone Script.doc	Yes	Yes	Paper Only
Form and Instruction	5	Safety Screen	Visit prep and safety screen_OMB.doc	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 35,703

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	35,703	35,703
Annual IC Time Burden (Hours)	2,856	2,856
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Brochure-Eng	Brochure-Eng.pdf	09/13/2007
introductory letter	introductory letter.doc	09/13/2007

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