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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.