Information Collection

Telephone screener and script

IC 241595 under ICR 202004-0920-022 · OMB 0920-1298.

Documents and Forms

Document Name Document Type
Telephone screener and script Form and Instruction
Telephone screener and script Att C - Telephone Screening Script_UPDATED 05 14 2020.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Telephone screener and script	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	none	Telephone screener and script	Att C - Telephone Screening Script_UPDATED 05 14 2020.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Health and Demographic Surveys Conducted in Probability Samples of the US Population	FR Citation: 49 FR 37693

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	299	299

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.