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Caregiver Survey Recruitment Screener
Targeted Surveillance and Biometric Studies for Enhanced Evaluation of CTGs
OMB: 0920-0977
IC ID: 203631
OMB.report
HHS/CDC
OMB 0920-0977
ICR 201305-0920-002
IC 203631
( )
Documents and Forms
Document Name
Document Type
Caregiver Survey Recruitment Screener
Form
Caregiver Screener
Att 11E_Caregiver Screener.docx
Form
Spanish Caregiver Screener
Att S11E_ Caregiver Screener Spanish.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Caregiver Survey Recruitment Screener
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Removed
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
none
Caregiver Screener
Att 11E_Caregiver Screener.docx
Yes
Yes
Fillable Fileable
Form
none
Spanish Caregiver Screener
Att S11E_ Caregiver Screener Spanish.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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:
800
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
0
0
0
0
0
0
Annual IC Time Burden (Hours)
0
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.