OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Screener

IC 215651 under ICR 201503-0910-008 · OMB 0910-0790.

Documents and Forms
Document Name
Document Type
Other-Contact Letter with Screener
Other-Consent Form
Other-Follow up letter
Information Collection (IC) Details

View Information Collection (IC)

Screener
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Contact Letter with Screener Attachment A--Initial Contact Letter with Screener.doc No   Printable Only
Other-Consent Form Attachment B--Consent Form In Person.doc No   Printable Only
Other-Follow up letter Attachment C--Follow-Up Letter.doc No   Printable Only

Health Consumer Health and Safety

 

60 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 60 0 60 0 0 0
Annual IC Time Burden (Hours) 5 0 5 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.