Survey 2 Screener Call (Not Interested)

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

Documents and Forms

Document Name Document Type
Form 3 Survey 2 Screener Call (Not Interested) Form and Instruction
3 Survey 2 Claimant Screener script Attachment 9_Survey 2 screener.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Survey 2 Screener Call (Not Interested)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	3	Survey 2 Claimant Screener script	Attachment 9_Survey 2 screener.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	25	25
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.