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Federal forms, ICRs, and supporting documents

Information Collection

Adult -Screener for main data collection

IC 234609 under ICR 201812-0910-008 · OMB 0910-0866.

Documents and Forms
Document Name
Document Type
Other-Screener Survey
Information Collection (IC) Details

View Information Collection (IC)

Adult -Screener for main data collection
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screener Survey Screener Survey.docx Yes Yes Fillable Fileable Signable

Health Consumer Health and Safety

 

51,054 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 51,054 0 0 51,054 0 0
Annual IC Time Burden (Hours) 1,532 0 0 1,532 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.