Information Collection

Introductory Screening Interview

IC 184629 under ICR 200804-0920-004 · OMB 0920-0805.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0805 can be found here:

Documents and Forms

Document Name Document Type
REACH US Screening Interview.doc Other-Telephone Screening Script
Attachment 5. Advance Letter.doc Attachment 5 - Advance Letter to Respondents IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Introductory Screening Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Telephone Screening Script			REACH US Screening Interview.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100,500	100,500
Annual IC Time Burden (Hours)	3,350	3,350
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 5 - Advance Letter to Respondents	Attachment 5. Advance Letter.doc	04/08/2008

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