OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Screener Document

IC 188039 under ICR 200908-0920-004 · OMB 0920-0811.

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

View Information Collection (IC)

Screener Document
 
No Modified
 
Voluntary
 

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

Health Illness Prevention

 

96 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 96 0 0 0 0 96
Annual IC Time Burden (Hours) 16 0 0 0 0 16
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.