Information Collection

Adult Screener

IC 228327 under ICR 201708-0910-011 · OMB 0910-0848.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A_GWL Adult Study Invitation E-mail Clean.docx	Other-Invitation E-mail
Appendix B_GWL Parent Invite Permission Clean.docx	Other-Parent Invite Permision
Appendix E_GWL Study Screener_Clean.docx	Other-Study Screener

IC Title:

Adult Screener

Agency IC Tracking Number:

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Invitation E-mail	Appendix A_GWL Adult Study Invitation E-mail Clean.docx	Yes	Yes	Fillable Fileable
Other-Parent Invite Permision	Appendix B_GWL Parent Invite Permission Clean.docx	Yes	Yes	Fillable Fileable
Other-Study Screener	Appendix E_GWL Study Screener_Clean.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12,412

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12,412	12,412
Annual IC Time Burden (Hours)	410	410
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.