OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Screening Form (NYBC)

IC 194328 under ICR 201008-0920-012 · OMB 0920-0873.

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

View Information Collection (IC)

Screening Form (NYBC)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD 0920-10CM_Att3b_Screening Form (NYBC).docx Yes Yes Fillable Printable
Other-Word 0920-10CM_Att3b_Screening Form NYBC 11[1].15.2010-clean.docx Yes Yes Fillable Printable

Health Illness Prevention

 

214 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 214 0 214 0 0 0
Annual IC Time Burden (Hours) 36 0 36 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Consent Forms -- NYBC 0920-10CM_Att4b_Consent Forms (NYBC).doc 07/26/2010
Script for Recruitment 0920-10CM_Att5b2_Script for Recruitment (NYBC).doc 07/29/2010
Recruitment Card Flyer 0920-10CM_Att5b1_Recruitment Card Flyer (NYBC).doc 07/29/2010
Telephone Script 0920-10CM_Att5b3_Telephone Scripts (NYBC).doc 07/29/2010
Reminder Letters 0920-10CM_Att5b4_Reminder Letters (NYBC).doc 07/29/2010
0920-10CM_Att4b_Consent Forms 8NYBC 11[1].15.2010-clean 0920-10CM_Att4b_Consent Forms 8NYBC 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.