Information Collection

Telephone Paticipant Screener

IC 191590 under ICR 200912-0910-004 · OMB 0910-0656.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0656 can be found here:

Documents and Forms

Document Name Document Type
GF Telephone Screener Rev.10-14-09.doc Other-Screener

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Telephone Paticipant Screener	Agency IC Tracking Number:

Is this a Common Form?		IC Status: New

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
Other-Screener			GF Telephone Screener Rev.10-14-09.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.