Information Collection

Attachment 10: BEEA Schedule Home Visit Scripts for AHS

IC 192871 under ICR 201302-0925-004 · OMB 0925-0406.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0406 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Attachment 10: BEEA Schedule Home Visit Scripts for AHS Form and Instruction
1 BEEA Previsit Reminder Script Attachment 10-1_BEEA_Previsit_Reminder_CallScripts.docx Form and Instruction
2 BEEA Iowa Schedule PostApp Visit Script Attachment 10-2_BEEA_IO_Sched_PostApp_Visit_Script.docx Form and Instruction
3 BEEA North Carolina Schedule PostApp Visit Script Attachment 10-3_BEEA_NC_Sched_PostApp_Visit_Script.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment 10: BEEA Schedule Home Visit Scripts for AHS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	BEEA Previsit Reminder Script	Attachment 10-1_BEEA_Previsit_Reminder_CallScripts.docx	No	No	Printable Only
Form and Instruction	2	BEEA Iowa Schedule PostApp Visit Script	Attachment 10-2_BEEA_IO_Sched_PostApp_Visit_Script.docx	No	No	Printable Only
Form and Instruction	3	BEEA North Carolina Schedule PostApp Visit Script	Attachment 10-3_BEEA_NC_Sched_PostApp_Visit_Script.docx	No	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: SORN #09-25-0200, Clinical, Epidemiologic, and Biometric Studies of the National Institutes of Health (NIH), HHS/NIH/ OD	FR Citation: 67 FR 60776

Number of Respondents: 20	Number of Respondents for Small Entity: 20

Affected Public: Private Sector	Private Sector: Farms

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	60	30	30
Annual IC Time Burden (Hours)	5	2	3
Annual IC Cost Burden (Dollars)	0	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.