Information Collection

Att. H_Screener Script Guide

IC 221945 under ICR 201606-0920-004 · OMB 0920-1145.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att. H_Screener Script Guide_051916.DOCX	Other-WORD

IC Title:

Agency IC Tracking Number:

16CA

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
Other-WORD					No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0160 "Records of Subjects in Health Promotion and Education Studies"

FR Citation: 51 FR 42484

Number of Respondents: 667

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	667	667
Annual IC Time Burden (Hours)	111	111
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.

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