Mall Intercept Screener & Moderator Guide - All

Evaluation of Health Communication Messages for Infertility Prevention Campaign

Documents and Forms

Document Name Document Type
VS_0920-08AA_Attachment 3B_Mall Intercept Screener & Mod Guide[15-25].doc Other-Screener and Moderator Guide

Information Collection (IC) Details

IC Title:	Mall Intercept Screener & Moderator Guide - All	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
Other-Screener and Moderator Guide			VS_0920-08AA_Attachment 3B_Mall Intercept Screener & Mod Guide[15-25].doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 132	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	132	-68	200
Annual IC Time Burden (Hours)	22	-11	33
Annual IC Cost Burden (Dollars)	0	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.