Information Collection

Homeless Shelter Staff - Homeless Shelter Modified Screener

IC 241642 under ICR 202009-0920-012 · OMB 0920-1297.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Homeless Shelter Staff - Homeless Shelter Modified Screener	Form and Instruction
Homeless Shelter Modified Screener 9. homeless_homeless shelter modified screener_instrument_OMB (omb)_ko.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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 and Instruction	NA	Homeless Shelter Modified Screener	9. homeless_homeless shelter modified screener_instrument_OMB (omb)_ko.docx	NA	No		Paper Only

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 92812

Number of Respondents: 2,400

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	4,800	4,800
Annual IC Time Burden (Hours)	1,200	1,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.