Adult Biometric Measures Recruitment Screener (phone/paper)

Targeted Surveillance and Biometric Studies for Enhanced Evaluation of CTGs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0977 can be found here:

Documents and Forms

Document Name Document Type
Adult Biometric Measures Recruitment Screener (phone/paper) Form
Biometric Screener Att 10_Adult BioMeas Screener.doc Form
Spanish Biometric Screener Att S10_AdultBioMeasScreener Spanish.docx Form

Information Collection (IC) Details

IC Title:	Adult Biometric Measures Recruitment Screener (phone/paper)	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	none	Biometric Screener	Att 10_Adult BioMeas Screener.doc		Yes	Yes	Fillable Fileable
Form	none	Spanish Biometric Screener	Att S10_AdultBioMeasScreener Spanish.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	267	267
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.