Screening Interview

Racial and Ethnic Approaches to Community Health across the U.S. (REACH U.S.) Evaluation

OMB: 0920-0805

IC ID: 184629

Information Collection (IC) Details

View Information Collection (IC)

Screening Interview
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Household Screening Interview for Telephone Interviewing Attachment 2a. Household Screening Interview.doc Yes Yes Fillable Printable

Health Public Health Monitoring

 

14,700 0
   
Individuals or Households
 
   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 14,700 0 -85,800 0 0 100,500
Annual IC Time Burden (Hours) 735 0 -2,615 0 0 3,350
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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