Information Collection

LGBT young adults media tracking screener

IC 218382 under ICR 201810-0910-015 · OMB 0910-0808.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment5_ScreenerInformedConsent FU2.docx	Other-Screener Informed Consent
Attachment 03 New Participant Screener_FU5.docx	Other-Screener

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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
Other-Screener Informed Consent			Attachment5_ScreenerInformedConsent FU2.docx		Yes	Yes	Fillable Fileable
Other-Screener			Attachment 03 New Participant Screener_FU5.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,668

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-1,668	1,668
Annual IC Time Burden (Hours)	-138	138
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.