Screener

Understanding Relationship Dynamics and Conflict Survey--Formative Study

OMB: 0920-1206

IC ID: 226223

Documents and Forms
Information Collection (IC) Details

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Screener
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Screener Attachment D Screener Survey_072616 JH.DOCX Yes Yes Fillable Fileable

Health Public Health Monitoring

 

4,300 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,300 0 0 0 0 4,300
Annual IC Time Burden (Hours) 358 0 0 0 0 358
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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