Information Collection

Outcome Screener in Person

IC 218387 under ICR 201606-0910-006 · OMB 0910-0808.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0808 can be found here:

Documents and Forms

Document Name Document Type
Attachment8_ScriptforRecruitingInterceptParticipants.docx Other-Script for Recruiting Intercep
Attachment5_ScreenerInformedConsent.docx Other-Screener Informed Consent
Attachment3_Screener.docx Other-Screener

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Outcome Screener in Person	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screener	Attachment3_Screener.docx	Yes	Yes	Fillable Fileable
Other-Script for Recruiting Intercept Participants	Attachment8_ScriptforRecruitingInterceptParticipants.docx	No		Printable Only
Other-Screener Informed Consent	Attachment5_ScreenerInformedConsent.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,059	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6,059	6,059
Annual IC Time Burden (Hours)	504	504
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.