Information Collection

Att 1 Pre-Screening Telephone Interview

IC 197717 under ICR 201105-0925-003 · OMB 0925-0640.

Documents and Forms

Document Name Document Type
Form 1 Att 1 Pre-Screening Telephone Interview Form
1 Att 1 Pre-Screening Telephone Interview Att.1 Pre-Screener Telephone Interview.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Att 1 Pre-Screening Telephone Interview	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	1	Att 1 Pre-Screening Telephone Interview	Att.1 Pre-Screener Telephone Interview.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: SORN #09-25-200, "Clinical, Basic, and Population-based Research Studies of the National Institutes of Health (NIH), HHS/NIH/OD."	FR Citation: 67 FR 60776

Number of Respondents: 1,334	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	1,334	1,334
Annual IC Time Burden (Hours)	334	334
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.