Information Collection

Screening/Participation Instruments

IC 197102 under ICR 201103-1505-006 · OMB 1505-0233.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0233 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PRA tool Acknowledgement Letter to Participants 0511.doc	Other-Acknowledgement Letter
PRA tool consent forms 051111.doc	Other-Consent Form
PRA tool consumer recruitment phone script.doc	Other-Recruitment Script
PRA tool industry recruitment phone script.doc	Other-Recruitment Script
PRA tool moderators guide consumer 0511.docx	Other-Moderator's Guide
PRA tool moderators guide industry 0511.docx	Other-Moderator's Guide
PRA tool participant questionaire 051111.doc	Other-Participant Questionaire
PRA tool Participant Reminder Telephone Script 0511.doc	Other-Participant Reminder
PRA tool scenario cards 051111.doc	Other-Scenario Cards
Description of Study-Overview.doc Description of Study/Overview	IC Document

IC Title:

Screening/Participation Instruments

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Recruitment Script	PRA tool industry recruitment phone script.doc	No	Paper Only
Other-Moderator's Guide	PRA tool moderators guide consumer 0511.docx	No	Paper Only
Other-Consent Form	PRA tool consent forms 051111.doc	No	Paper Only
Other-Recruitment Script	PRA tool consumer recruitment phone script.doc	No	Paper Only
Other-Moderator's Guide	PRA tool moderators guide industry 0511.docx	No	Paper Only
Other-Acknowledgement Letter	PRA tool Acknowledgement Letter to Participants 0511.doc	No	Paper Only
Other-Participant Reminder	PRA tool Participant Reminder Telephone Script 0511.doc	No	Paper Only
Other-Scenario Cards	PRA tool scenario cards 051111.doc	No	Paper Only
Other-Participant Questionaire	PRA tool participant questionaire 051111.doc	No	Paper Only

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 230

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	230	230
Annual IC Time Burden (Hours)	315	315
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Description of Study/Overview	Description of Study-Overview.doc	04/05/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.