Information Collection

General population – outcome screener (in person)

IC 218387 under ICR 201807-0910-007 · OMB 0910-0808.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0808 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 8 Script for Recruiting Intercept Participants_FU4.docx	Other-Script for Recruiting Intercep
Attachment 5 CrossSectional Screener Inf Con FU3.docx	Other-Screener Informed Consent
Attachment 03 New Participant Screener_FU5.docx	Other-Screener
Attachment 02b_Video Storyboards FU5.pdf	Other-Video Storyboards FU5

IC Title:

General population â outcome screener (in person)

Agency IC Tracking Number:

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Script for Recruiting Intercept Participants	Attachment 8 Script for Recruiting Intercept Participants_FU4.docx	No		Printable Only
Other-Screener Informed Consent	Attachment 5 CrossSectional Screener Inf Con FU3.docx	Yes	Yes	Fillable Fileable
Other-Screener	Attachment 03 New Participant Screener_FU5.docx	Yes	Yes	Fillable Fileable
Other-Video Storyboards FU5	Attachment 02b_Video Storyboards FU5.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9,255

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	9,255	1,984	7,271
Annual IC Time Burden (Hours)	768	163	605
Annual IC Cost Burden (Dollars)	0	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.