Information Collection

Radiation Dose Tool Feedback

IC 216345 under ICR 201305-0923-003 · OMB 0923-0047.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0047 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ATT C RDT Public Screener.docx	Other-Telephone Screener
ATT F RDT Interview Guide for Public.docx	Other-Interview Guide
ATT D RDT PIO and Public Planners Screener.docx	Other-Telephone Screener
ATT G RDT Interview Guide for Public Health.docx	Other-Interview Guide
Appendix H Radiation Dose Tool.pptx Radiation Dose Tool	IC Document
ATT A RDT Protocol Summary.docx RDT Protocol Summary	IC Document
ATT B RDT Protocol.docx RDT Protocol	IC Document
ATT E Participant Info Sheet.docx Participant Info Sheet	IC Document
Request for Service Delivery GenIC 0923-0047 Radiation Dose Tool.pdf Request for Approval	IC Document

IC Title:

Radiation Dose Tool Feedback

Agency IC Tracking Number:

15AFB

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Telephone Screener	ATT C RDT Public Screener.docx	Yes	Yes	Fillable Printable
Other-Interview Guide	ATT F RDT Interview Guide for Public.docx	No		Paper Only
Other-Telephone Screener	ATT D RDT PIO and Public Planners Screener.docx	Yes	Yes	Fillable Printable
Other-Interview Guide	ATT G RDT Interview Guide for Public Health.docx	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 108

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	108	108
Annual IC Time Burden (Hours)	48	48
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Radiation Dose Tool	Appendix H Radiation Dose Tool.pptx	04/29/2015
RDT Protocol Summary	ATT A RDT Protocol Summary.docx	04/29/2015
RDT Protocol	ATT B RDT Protocol.docx	04/29/2015
Participant Info Sheet	ATT E Participant Info Sheet.docx	04/29/2015
Request for Approval	Request for Service Delivery GenIC 0923-0047 Radiation Dose Tool.pdf	04/29/2015

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