Information Collection

Pre-Test for Smartphone Feasibility Study

IC 202850 under ICR 201206-0920-006 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appx C1_CATI Screener.doc	Other-Word
Appx D_CATI Recruitment.doc	Other-Word
Appx C2_CATI Informed Consent.doc Appx C2_CATI Informed Consent	IC Document

IC Title:

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Word			Appx C1_CATI Screener.doc		Yes	Yes	Fillable Printable
Other-Word			Appx D_CATI Recruitment.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appx C2_CATI Informed Consent	Appx C2_CATI Informed Consent.doc	06/14/2012

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