Information Collection

Telephone Recruitment Script and Screener - Los Angeles Site

IC 205132 under ICR 201212-0970-004 · OMB 0970-0434.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A-2 - Telephone Recruitment Script and Screener - Los Angeles Site REV.docx	Other-Screening Material
Appendix A-2S - Telephone Recruitment Script and Screener (Spanish) - Los Angeles Site.docx Appendix A-2S - Telephone Recruitment Script and Screener (Spanish) - Los Angeles Site	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-Screening Material			Appendix A-2 - Telephone Recruitment Script and Screener - Los Angeles Site REV.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

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	100	100
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix A-2S - Telephone Recruitment Script and Screener (Spanish) - Los Angeles Site	Appendix A-2S - Telephone Recruitment Script and Screener (Spanish) - Los Angeles Site.docx	12/11/2012

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