Information Collection

National Recovery Month's Public Serive Announcement

IC 218991 under ICR 201306-0930-003 · OMB 0930-0196.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0196 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Screener National Recovery Month's Public Serive Announcement	Form and Instruction
Screener Screener ATTACHMENT A - Screening Questionnaire.docx	Form and Instruction
Consent form-guide Consent form-guide-scripts ATTACHMENT B - Consent form-guide-scripts.docx	Form and Instruction
CSAT Focus Groups - OMB Supporting Statement.doc Justification	IC Document
TransLet-2.doc Letter	IC Document

IC Title:

National Recovery Month's Public Serive Announcement

Agency IC Tracking Number:

IC Status: New

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	Screener	Screener	ATTACHMENT A - Screening Questionnaire.docx		Yes	Yes	Fillable Fileable
Form and Instruction	Consent form-guide-scripts	Consent form-guide-scripts	ATTACHMENT B - Consent form-guide-scripts.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	40	40
Annual IC Time Burden (Hours)	51	51
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification	CSAT Focus Groups - OMB Supporting Statement.doc	11/16/2015
Letter	TransLet-2.doc	11/16/2015

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