Information Collection

BEEA CATI Screening Script for RSG Eligibility, REG Eligibility or AMG Eligibility

IC 220894 under ICR 201604-0925-001 · OMB 0925-0406.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 BEEA CATI Screening Script for RSG Eligibility, REG Eligibility or AMG Eligibility	Form and Instruction
4 Attachment 20-1 BEEA CATI Script Random Select Group Attachment 20-1_BEEA_CATI Script_Random Select Group_highlighted.pdf	Form and Instruction
5 Attachment 20-2 BEEA CATI Script Recent Exposed Group Attachment 20-2_BEEA_CATI Script_Recent Exposed Group_highlighted.pdf	Form and Instruction
6 Attachment 20-3 BEEA CATI Script Recently Exposed +Air M Attachment 20-3_BEEA_CATI Script_Recently Exposed + Air Monitoring Group_highlighted.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	4	Attachment 20-1 BEEA CATI Script Random Select Group	Attachment 20-1_BEEA_CATI Script_Random Select Group_highlighted.pdf	No	Paper Only
Form and Instruction	5	Attachment 20-2 BEEA CATI Script Recent Exposed Group	Attachment 20-2_BEEA_CATI Script_Recent Exposed Group_highlighted.pdf	No	Paper Only
Form and Instruction	6	Attachment 20-3 BEEA CATI Script Recently Exposed +Air Monitoring Group	Attachment 20-3_BEEA_CATI Script_Recently Exposed + Air Monitoring Group_highlighted.pdf	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09-25-0200 Clinical, Basic and Population-based Research Studies

FR Citation: 67 FR 60776

Number of Respondents: 480

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
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.