OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Screening Form (SUNY)

IC 194327 under ICR 201008-0920-012 · OMB 0920-0873.

Documents and Forms
Document Name
Document Type
Other-WORD
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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Screening Form (SUNY)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD 0920-10CM_Att3a_Screening Form (SUNY).doc Yes Yes Fillable Printable

Health Illness Prevention

 

200 0
   
Individuals or Households
 
   100 %

  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 200 0 200 0 0 0
Annual IC Time Burden (Hours) 33 0 33 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Consent Forms -- SUNY 0920-10CM_Att4a_Consent Forms (SUNY).doc 07/26/2010
Recruitment Script 0920-10CM_Att5a1_Recruitment Script (SUNY).doc 07/26/2010
Contact and Appointment Card 0920-10CM_Att5a2_Contact and Appointment Card (SUNY).doc 07/29/2010
Reminder Call Script 0920-10CM_Att5a3_Reminder Call Script (SUNY).doc 07/26/2010
0920-10CM_Att4a_Consent Forms SUNY 11[1].15.2010-clean 0920-10CM_Att4a_Consent Forms SUNY 11[1].15.2010-clean.docx 11/22/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.