Information Collection

ABC Screener (Attachment 2)

IC 208639 under ICR 201309-0925-002 · OMB 0925-0684.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0684 can be found here:

Documents and Forms

Document Name Document Type
Form 1 ABC Screener (Attachment 2) Form
1 ABC Survey-Screener Attach2_ABC Screener_5-1-2013.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	ABC Screener (Attachment 2)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	1	ABC Survey-Screener	Attach2_ABC Screener_5-1-2013.docx		No	No	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: Clinical, Basic and Population-based Research Studies of hte National Institutes of Health (NIH)	FR Citation: 67 FR 60776

Number of Respondents: 8,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,000	8,000
Annual IC Time Burden (Hours)	667	667
Annual IC Cost Burden (Dollars)	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.