FY16 Generic Screeners

Generic Clearance for Questionnaire Pretesting Research

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0725 can be found here:

Documents and Forms

Document Name Document Type
Form Internet Screener FY16 Generic Screeners Form
Internet Screener Internet Screener FY16_Recruitment_Screener_Internet_Participate (updated 10-7) Spanish additions in red OMB submission version.docx Form
Telephone Screener Telephone Screener FY16_Recruitment_Screener_Telephone (updated 10-7) Spanish additions in red OMB submission version.docx Form
OMB0607-0725_FY16_Recruitment_Screener.docx Memo IC Document

Information Collection (IC) Details

IC Title:	FY16 Generic Screeners	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 13 CFR Sections 191, 143 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Internet Screener	Internet Screener	FY16_Recruitment_Screener_Internet_Participate (updated 10-7) Spanish additions in red OMB submission version.docx		Yes	Yes	Paper Only
Form	Telephone Screener	Telephone Screener	FY16_Recruitment_Screener_Telephone (updated 10-7) Spanish additions in red OMB submission version.docx		Yes	Yes	Printable Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	334	334
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Memo	OMB0607-0725_FY16_Recruitment_Screener.docx	10/26/2015

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