Adult Biometric Measures - screener

Targeted Surveillance and Biometric Studies for Enhanced Evaluation of CTGs

Documents and Forms

Document Name Document Type
Adult Biometric Measures - screener Form
Adult Biometric Measures Recruitment Screener Att 10A_AdultBio_Screener_PostCATI.docx Form
Adult Biometric Measures Recruitment Screener-Spanish Att 10A-S_AdultBio_Screener_PostCATI_SP.docx Form
Adult Biometric Measures Recruitment Screener Att 10C_AdultBio_PaperInvitation_Screener_CallIns.docx Form
Adult Biometric Measures Recruitment Screener - Spanish Att 10C-S_AdultBio_PaperInvitation_Screener_CallIns_SP.docx Form
Att 10B_EnhancedInvitation_forATSS_Paper.docx 10b - Invitation to participate IC Document
Att 10B-S_EnhancedInvitation_forATSS_Paper_SP.docx 10b(s) - Invitation to participate - Spanish IC Document
Att 10D_Paper Telephone Info Sheet.docx Att 10D_Paper Telephone Info Sheet IC Document
Att 10D-S_Paper Telephone Info Sheet_SP.docx Att 10D-S_Paper Telephone Info Sheet_SP IC Document
Att 12C_AdultBioMeasures_ItemSources_2013_0618.pdf Att 12C_AdultBioMeasures_ItemSources_2013_0618 IC Document

Information Collection (IC) Details

IC Title:	Adult Biometric Measures - screener	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	none	Adult Biometric Measures Recruitment Screener	Att 10A_AdultBio_Screener_PostCATI.docx	Yes	Yes	Fillable Fileable
Form	none	Adult Biometric Measures Recruitment Screener-Spanish	Att 10A-S_AdultBio_Screener_PostCATI_SP.docx	Yes	Yes	Fillable Fileable
Form	none	Adult Biometric Measures Recruitment Screener	Att 10C_AdultBio_PaperInvitation_Screener_CallIns.docx	No	No	Paper Only
Form	none	Adult Biometric Measures Recruitment Screener - Spanish	Att 10C-S_AdultBio_PaperInvitation_Screener_CallIns_SP.docx	No	No	Paper Only

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: 4,418	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,418	4,418
Annual IC Time Burden (Hours)	736	736
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
10b - Invitation to participate	Att 10B_EnhancedInvitation_forATSS_Paper.docx	04/22/2013
10b(s) - Invitation to participate - Spanish	Att 10B-S_EnhancedInvitation_forATSS_Paper_SP.docx	04/22/2013
Att 10D_Paper Telephone Info Sheet	Att 10D_Paper Telephone Info Sheet.docx	08/06/2013
Att 10D-S_Paper Telephone Info Sheet_SP	Att 10D-S_Paper Telephone Info Sheet_SP.docx	08/06/2013
Att 12C_AdultBioMeasures_ItemSources_2013_0618	Att 12C_AdultBioMeasures_ItemSources_2013_0618.pdf	08/06/2013

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