Information Collection

Adult - Screener

IC 236639 under ICR 202008-0910-017 · OMB 0910-0880.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0880 can be found here:

Documents and Forms

Document Name Document Type
Appendix N HPHC2 Online Survey Adult Invitation Email_CLEAN.docx Other-Adult Invitation Email
Appendix J HPHC2 Online Survey Screener_CLEAN.docx Other-Online Screener

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adult - Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-Adult Invitation Email			Appendix N HPHC2 Online Survey Adult Invitation Email_CLEAN.docx		Yes	Yes	Fillable Fileable Signable
Other-Online Screener			Appendix J HPHC2 Online Survey Screener_CLEAN.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	12,000	12,000
Annual IC Time Burden (Hours)	600	600
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.