Survey 1- Screener Call (not interested)

Calibration II & Predictive Validity Testing of Item Response Theory – Computer Adaptive Testing Tools (IRT-CAT)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0704 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Survey 1- Screener Call (not interested) Form and Instruction
1 Claimant Screener Survey 1 Attachment 8_Claimant Screener Script Survey 080814.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Survey 1- Screener Call (not interested)	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	1	Claimant Screener Survey 1	Attachment 8_Claimant Screener Script Survey 080814.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,200	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	12,200	12,200
Annual IC Time Burden (Hours)	610	610
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.