Notification of New Top-Screen Instrument Scope

Notification of New Top-Screen Instrument

Name of Instrument

Notification of New Top-Screen

Scope of Instrument

This instrument collects:

• Personally identifiable information from the individual submitting request

• Relevant facility information

• Relevant information for the notification of new Top-Screen

Example of DHS Forms used within the scope of this instrument

Attached is DHS Form 9035 that is used to standardize the collection of information within this instrument. DHS Form 9035 identifies most, but not all of the data routinely collected under this instrument.

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