Information Collection

PATH/Baseline - Adults Individual Screener

IC 203756 under ICR 201208-0925-002 · OMB 0925-0664.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0664 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2b PATH/Baseline - Adults Individual Screener	Form
2b Adults Individual Screener/Baseline 2b. Individual Screener 6.2 2012-08-16.pdf	Form

IC Title:

PATH/Baseline - Adults Individual Screener

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
Form	2b	Adults Individual Screener/Baseline	2b. Individual Screener 6.2 2012-08-16.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: NIH Privacy Act System of Records 09-25-0200 Clinical, Basic Population-based research studies of NIH, HHS/NIH/OD

FR Citation: 67 FR 60741

Number of Respondents: 63,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	63,000	63,000
Annual IC Time Burden (Hours)	6,300	6,300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.