Information Collection

Screening Process for Parents Recruited to Parent-only Groups in Phase 3

IC 184646 under ICR 200804-0920-005 · OMB 0920-0795.

Documents and Forms

Document Name Document Type
Appendix D3 Screener for Parent-Only groups Phase 3.doc Other-Recruitment Screening Instrume

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Screening Process for Parents Recruited to Parent-only Groups in Phase 3	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-Recruitment Screening Instrument for Parent-only Focus Groups			Appendix D3 Screener for Parent-Only groups Phase 3.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 288	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	288	288
Annual IC Time Burden (Hours)	34	34
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.