Information Collection

Adult Case Subjects Screening Process

IC 210427 under ICR 201402-0920-014 · OMB 0920-1013.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1013 can be found here:

Documents and Forms

Document Name Document Type
Form 0920 Adult Case Subjects Screening Process Form and Instruction
0920 Attachment C_Adult case and control Screening forms Attachment C_Adult case and control Screening forms_1_24_14.docx Form and Instruction
SPANISH TRANSLATION_Attachment J_Adult Case and Control Screening Forms 1_24_14.docx SPANISH TRANSLATION_Attachment J_Adult Case and Control Screening Forms IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adult Case Subjects Screening Process	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 and Instruction	0920	Attachment C_Adult case and control Screening forms	Attachment C_Adult case and control Screening forms_1_24_14.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 129	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	129	129
Annual IC Time Burden (Hours)	11	11
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SPANISH TRANSLATION_Attachment J_Adult Case and Control Screening Forms	SPANISH TRANSLATION_Attachment J_Adult Case and Control Screening Forms 1_24_14.docx	02/14/2014

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