Information Collection

Adult Biometric Measures - screener

IC 203626 under ICR 201305-0920-002 · OMB 0920-0977.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.