Information Collection

BEEA Pre-Homme Visit Script

IC 220901 under ICR 201604-0925-001 · OMB 0925-0406.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 12 BEEA Pre-Homme Visit Script	Form and Instruction
12 Attachment 10-1 BEEA Previsit Reminder Call Script Attachment 10-1_BEEA_Previsit_Reminder_CallScripts.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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	12	Attachment 10-1 BEEA Previsit Reminder Call Script	Attachment 10-1_BEEA_Previsit_Reminder_CallScripts.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: 160

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	160	160
Annual IC Time Burden (Hours)	5	5
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.