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Federal forms, ICRs, and supporting documents

Information Collection

Screening Eligibility Assessment (SEA) Form

IC 185935 under ICR 200807-0935-002 · OMB 0935-0146.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Screening Eligibility Assessment (SEA) Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #2 Screening Eligibility Assessment (SEA) Form Attachment C1 -- A Screening Eligibility (SEA) Form.doc No No Paper Only

Health Consumer Health and Safety

 

7,500 0
   
Individuals or Households
 
   0 %

  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 7,500 0 7,500 0 0 0
Annual IC Time Burden (Hours) 1,250 0 1,250 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment D1 -- Screening Elibility Letter Attachment D1 -- Screening Elibility Letter.doc 07/25/2008
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.