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ABRT - behavioral assessment
Behavioral Assessment Component of the Behavioral Assessment and Rapid Testing (BART) Project
OMB: 0920-0883
IC ID: 195688
OMB.report
HHS/CDC
OMB 0920-0883
ICR 201012-0920-004
IC 195688
( )
Documents and Forms
Document Name
Document Type
ABRT - behavioral assessment
Form
Behavioral Assessment
Att5B updated 10_28_10 Questionnaire BART.doc
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
ABRT - behavioral assessment
Agency IC Tracking Number:
Is this a Common Form?
No
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
Form
none
Behavioral Assessment
Att5B updated 10_28_10 Questionnaire BART.doc
No
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
5,600
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
5,600
0
5,600
0
0
0
Annual IC Time Burden (Hours)
1,400
0
1,400
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.