Screener Document

Testing and Development of Materials Promoting Prevention and Control of Traumatic Brain Injury in Schools

Documents and Forms

Document Name Document Type
Form 1 Screener Document Form and Instruction
1 In-Depth Interview Screener Attachment 2- Screener Instrument for Nurses_Counselors_Psychologists_Administrators.09-0121.doc Form and Instruction
Attachment 2- Screener Instrument for Nurses_Counselors_Teachers_Administrators 09-0811.final.doc Revised Screener Instrument IC Document

Information Collection (IC) Details

IC Title:	Screener Document	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	1	In-Depth Interview Screener	Attachment 2- Screener Instrument for Nurses_Counselors_Psychologists_Administrators.09-0121.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 96	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	96	96
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Revised Screener Instrument	Attachment 2- Screener Instrument for Nurses_Counselors_Teachers_Administrators 09-0811.final.doc	08/20/2009

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