Information Collection

Recruitment Contact and Appoinment Confirmation

IC 182188 under ICR 200901-0925-003 · OMB 0925-0584.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0584 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Recruitment Contact and Appoinment Confirmation	Form and Instruction
2 Residential Response Resident Response.doc	Form and Instruction
1 In Person Script In-person Script.doc	Form and Instruction
3 App. Reminder Call Appt Reminder call_09-12-07.doc	Form and Instruction
4 Phone Script Phone Script.doc	Form and Instruction
5 Safety Screen Visit prep and safety screen_OMB.doc	Form and Instruction
Brochure-Eng.pdf Brochure-Eng	IC Document
introductory letter.doc introductory letter	IC Document

IC Title:

Recruitment Contact and Appoinment Confirmation

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	Residential Response	Resident Response.doc	Yes	Yes	Paper Only
Form and Instruction	1	In Person Script	In-person Script.doc	Yes	Yes	Paper Only
Form and Instruction	3	App. Reminder Call	Appt Reminder call_09-12-07.doc	Yes	Yes	Paper Only
Form and Instruction	4	Phone Script	Phone Script.doc	Yes	Yes	Paper Only
Form and Instruction	5	Safety Screen	Visit prep and safety screen_OMB.doc	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 35,703

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	Previously Approved
Annual Number of Responses for this IC	35,703	35,703
Annual IC Time Burden (Hours)	2,856	2,856
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Brochure-Eng	Brochure-Eng.pdf	09/13/2007
introductory letter	introductory letter.doc	09/13/2007

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