Information Collection

Attachment 20 or 21: BEEA CATI Screener for AHS

IC 192869 under ICR 201604-0925-001 · OMB 0925-0406.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Attachment 20 or 21: BEEA CATI Screener for AHS	Form and Instruction
3 CATI Eligibility Script_Recently Exposed Respondents Attachment 21_BEEA_CATI_Eligibility_Script_Recently_Exposed.docx	Form and Instruction
1 Attachment 20: BEEA CATI Script Attachment 20_BEEA_CATI Eligibility Script_Random Select Group_Dust.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3	CATI Eligibility Script_Recently Exposed Respondents	Attachment 21_BEEA_CATI_Eligibility_Script_Recently_Exposed.docx		Yes	No	Printable Only
Form and Instruction	1	Attachment 20: BEEA CATI Script	Attachment 20_BEEA_CATI Eligibility Script_Random Select Group_Dust.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: SORN #09-25-0200, Clinical, Epidemiologic, and Biometric Studies of the National Institutes of Health (NIH), HHS/NIH/ OD

FR Citation: 67 FR 60776

Number of Respondents: 480

Number of Respondents for Small Entity: 480

Affected Public: Private Sector

Private Sector: Farms

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-480	480
Annual IC Time Burden (Hours)	-160	160
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.