Information Collection

Invitation Call Script and SCQ (Mother)

IC 224021 under ICR 201610-0920-010 · OMB 0920-1171.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1171 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 21.c. Invitation Call Script - POP source selection SEED 3_3-7-17.docx	Other-WORD
Attachment 5. Social Communication Questionnaire (SCQ).pdf	Other-WORD
Attachment 5 CoverSheet_Social Communication Questionnaire (SCQ) pdf.doc Att 5 Cover Letter	IC Document

IC Title:

Invitation Call Script and SCQ (Mother)

Agency IC Tracking Number:

16PA

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			Attachment 5. Social Communication Questionnaire (SCQ).pdf		No		Fillable Printable
Other-WORD			Att 21.c. Invitation Call Script - POP source selection SEED 3_3-7-17.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0136: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 733

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	733	733
Annual IC Time Burden (Hours)	367	367
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 5 Cover Letter	Attachment 5 CoverSheet_Social Communication Questionnaire (SCQ) pdf.doc	10/26/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.