Information Collection

ABRT - behavioral assessment

IC 195688 under ICR 201012-0920-004 · OMB 0920-0883.

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

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 Agency Discretion
Annual Number of Responses for this IC	5,600	5,600
Annual IC Time Burden (Hours)	1,400	1,400
Annual IC Cost Burden (Dollars)	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.