Information Collection

Outcome Screener in Person

IC 218387 under ICR 201608-0910-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Attachment8_ScriptforRecruitingInterceptParticipants.docx	Other-Script for Recruiting Intercep
Attachment5_ScreenerInformedConsent.docx	Other-Screener Informed Consent
Attachment3_Screener.docx	Other-Screener

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:

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

table that charts list of burden
	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

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.