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Intake Assessment Screening Form for Expect Respect Support Groups (Intake Assessment)

IC 194254 under ICR 201307-0920-008 · OMB 0920-0861.

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Document Type
Other-WORD
Information Collection (IC) Details

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Intake Assessment Screening Form for Expect Respect Support Groups (Intake Assessment)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Att C - Intake Assessment Screening Form v1.doc No No Fillable Printable

Community and Social Services Social Services

Records of Subjects in Health Promotion and Education Studies  51 FR 42484

800 0
   
Individuals or Households
 
   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 800 0 0 0 0 800
Annual IC Time Burden (Hours) 200 0 0 0 0 200
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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