Information Collection

Att 1db_Model Patient Recruitment Script-Tex and E-mail

IC 180566 under ICR 201805-0920-003 · OMB 0920-0740.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0740 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 11d_MMP Recruitment Text E-mail.docx	Instruction
Att 11a_Model recruitment letter.docx 11a_Model Patient Recruitment Letter	IC Document

IC Title:

Att 1db_Model Patient Recruitment Script-Tex and E-mail

Agency IC Tracking Number:

0920-0222

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Att 11d_MMP Recruitment Text E-mail.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7,760

Number of Respondents for Small Entity: 936

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	7,760	-960	8,720
Annual IC Time Burden (Hours)	388	-48	436
Annual IC Cost Burden (Dollars)	9,677	-1,197	10,874

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
11a_Model Patient Recruitment Letter	Att 11a_Model recruitment letter.docx	05/17/2018

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