Information Collection

Screening and Consent Process (Phase 2Survey)

IC 200737 under ICR 201306-0920-008 · OMB 0920-0923.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0923 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Screening and Consent Process (Phase 2Survey)	Form and Instruction
Evaluation of the National Tobacco Prevention and Contro Att E-1. Revised Screener 6-11-13.docx	Form and Instruction
Att F-1. KN Recruitment Procedures.DOC Att F-1. KN Recruitment Procedures	IC Document
Att E-2. Email Notification and Reminders.doc Att E-2. Email Notification and Reminders	IC Document

IC Title:

Screening and Consent Process (Phase 2Survey)

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Evaluation of the National Tobacco Prevention and Control Public Education Screening Questionnaire	Att E-1. Revised Screener 6-11-13.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 43,737

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	Previously Approved
Annual Number of Responses for this IC	43,737	43,737
Annual IC Time Burden (Hours)	1,458	1,458
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att F-1. KN Recruitment Procedures	Att F-1. KN Recruitment Procedures.DOC	02/07/2013
Att E-2. Email Notification and Reminders	Att E-2. Email Notification and Reminders.doc	02/04/2013

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