Information Collection

Site Recruitment and Training

IC 239085 under ICR 201912-0915-001 · OMB 0915-0368.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0368 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Site Recruitment and Training	Form
2 Attachment10 National_Awardee and Site Recruitment Mater Attachment10 National_Awardee and Site Recruitment Materials_final 10_29_2019_psg.docx	Form
AT0E7D~1.DOC Attachment 13 Receptionist Recruitment Script_English_TChinese	IC Document
ATTACH~3.DOC Attachment 13 Receptionist Recruitment Script_Spanish	IC Document
ATTACH~1.DOC Attachment 13 Receptionist Recruitment Script_Vietnamese	IC Document
AT8625~1.DOC Attachment 13 Receptionist Recruitment Script_Tagalog	IC Document
AT5587~1.DOC Attachment 13 Interviewer Recruitment Script final_TChinese	IC Document
ATTACH~2.DOC Attachment 13 Interviewer Recruitment Script final_Spanish	IC Document
ATAF25~1.DOC Attachment 13 Interviewer Recruitment Script final_Tagalog	IC Document
AT3EB9~1.DOC Attachment 13 Interviewer Recruitment Script final_Vietnamese	IC Document

IC Title:

Site Recruitment and Training

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Form	2	Attachment10 National_Awardee and Site Recruitment Materials_3-23-20	Attachment10 National_Awardee and Site Recruitment Materials_final 10_29_2019_psg.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 700

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	700	700
Annual IC Time Burden (Hours)	2,205	2,205
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 13 Receptionist Recruitment Script_English_TChinese	AT0E7D~1.DOC	12/26/2019
Attachment 13 Receptionist Recruitment Script_Spanish	ATTACH~3.DOC	12/26/2019
Attachment 13 Receptionist Recruitment Script_Vietnamese	ATTACH~1.DOC	12/26/2019
Attachment 13 Receptionist Recruitment Script_Tagalog	AT8625~1.DOC	12/26/2019
Attachment 13 Interviewer Recruitment Script final_TChinese	AT5587~1.DOC	12/26/2019
Attachment 13 Interviewer Recruitment Script final_Spanish	ATTACH~2.DOC	12/26/2019
Attachment 13 Interviewer Recruitment Script final_Tagalog	ATAF25~1.DOC	12/26/2019
Attachment 13 Interviewer Recruitment Script final_Vietnamese	AT3EB9~1.DOC	12/26/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.