Information Collection

After You Deliver

IC 184622 under ICR 200712-0584-003 · OMB 0584-0524.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0524 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2-19-08ScreeningQuestionnaireEnglish_OMB_-FINAL.pdf	Other-Questionnaire
2-19-08ScreeningQuestionnaireSpanish_OMB_-FINAL.pdf	Other-Questionnaire Spanish
After You Deliver clearance memo.doc Clearance Memo	IC Document
PromotionalFlyer-English.pdf Recruitment Flyer English	IC Document
PromotionalFlyer-Spanish.pdf Recruitment Flyer	IC Document
After You Deliver ConfidentialityForm.pdf Confidentiality Agreement-English	IC Document
After You Deliver ConfidentialityForm-Spanish.pdf Confidentiality Agreement-Spanish	IC Document
2-19-08ModeratorGuideEnglish_OMB_-FINAL v2.pdf Moderator Guide English	IC Document
2-19-08ModeratorGuideSpanish_OMB_-FINAL v2.pdf Moderator Guide Spanish	IC Document
burden table.xls Burden Table	IC Document

IC Title:

After You Deliver

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 246.11

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-Questionnaire					No		Paper Only
Other-Questionnaire Spanish					No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 225

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	225	0	0	0	0	0
Annual IC Time Burden (Hours)	186	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
Clearance Memo		04/24/2008
Recruitment Flyer English		04/24/2008
Recruitment Flyer		04/24/2008
Confidentiality Agreement-English		04/24/2008
Confidentiality Agreement-Spanish		04/24/2008
Moderator Guide English		04/24/2008
Moderator Guide Spanish		04/24/2008
Burden Table		04/24/2008

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

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