OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Number to Complete the Screener

IC 198468 under ICR 201211-0910-002 · OMB 0910-0703.

Documents and Forms
Document Name
Document Type
Other-Screener
Information Collection (IC) Details

View Information Collection (IC)

Number to Complete the Screener
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screener APPENDIX E - Screener.doc No No Paper Only

Health Immunization Management

 

69,118 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 69,118 0 0 0 0 69,118
Annual IC Time Burden (Hours) 2,304 0 0 0 0 2,304
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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