Information Collection

Screening

IC 179581 under ICR 200906-0970-005 · OMB 0970-0322.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CHMI baseline survey - Instrument 1-Screener-03.22.07.doc	Other-screening

IC Title:

Screening

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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-screening			CHMI baseline survey - Instrument 1-Screener-03.22.07.doc		No	No	Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9,331

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-9,331	9,331
Annual IC Time Burden (Hours)	-560	560
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.