Information Collection

Pre-visit scheduling and safety screening

IC 182188 under ICR 201406-0925-002 · OMB 0925-0584.

Documents and Forms

Document Name Document Type
Form 1 Pre-visit scheduling and safety screening Form and Instruction
1 ELE-Participant eligibility - billingual ELE-Participant Eligiblity -billingual.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Pre-visit scheduling and safety screening	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 and Instruction	1	ELE-Participant eligibility - billingual	ELE-Participant Eligiblity -billingual.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13,878	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	Previously Approved
Annual Number of Responses for this IC	13,878	12,545	1,333
Annual IC Time Burden (Hours)	463	-537	1,000
Annual IC Cost Burden (Dollars)	0	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.