Att 11c_Model Patient Recruitment Script - Facility

Medical Monitoring Project

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Att 11c_Recruitment Script Facility.docx Instruction

Information Collection (IC) Details

IC Title:	Att 11c_Model Patient Recruitment Script - Facility	Agency IC Tracking Number:	0920-0222

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Att 11c_Recruitment Script Facility.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 970	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	970	-120	1,090
Annual IC Time Burden (Hours)	81	-10	91
Annual IC Cost Burden (Dollars)	2,020	-250	2,270

Documents for IC

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.