Information Collection

Agency Screening

IC 233937 under ICR 201811-2127-003 · OMB 2127-0742.

Documents and Forms

Document Name Document Type
Form 1460 Agency Screening Form and Instruction
1460 EMS Agency Telephone Screening Form Form 1460-AgencyLevelEmailPhoneScreeningForm.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Agency Screening	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Form and Instruction	1460	EMS Agency Telephone Screening Form	Form 1460-AgencyLevelEmailPhoneScreeningForm.docx		No		Paper Only

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

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.