Information Collection

Emergency Departments Study Screener

IC 183186 under ICR 201104-0920-002 · OMB 0920-0775.

Documents and Forms

Document Name Document Type
Emergency Departments Study Screener Form
Emergency Dept. Routine HIV Testing Screener A6a Screening Instruments-Routine Testing.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Emergency Departments Study Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Emergency Dept. Routine HIV Testing Screener	A6a Screening Instruments-Routine Testing.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	12	-24	36
Annual IC Time Burden (Hours)	2	-4	6
Annual IC Cost Burden (Dollars)	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.