Household Survey for General Public_Study Screener

Public Health Systems, Mental Health and Community Recovery Project

Documents and Forms

Document Name Document Type
Household Survey for General Public_Study Screener Form
Household Screener Revised Attachment H_ Household Survey for General Public_Study Screener....docx Form

Information Collection (IC) Details

IC Title:	Household Survey for General Public_Study Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	none	Household Screener	Revised Attachment H_ Household Survey for General Public_Study Screener....docx		Yes	No	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Repair and Restore

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,252	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	5,252	5,252
Annual IC Time Burden (Hours)	175	175
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.