Information Collection

Phase 3 - ABS, paper screener

IC 239167 under ICR 202105-0920-008 · OMB 0920-0822.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0822 can be found here:

Documents and Forms

Document Name Document Type
Phase 3 - ABS, paper screener Form
ABS paper screener Att F.2_Paper Screener_CLEAN.docx Form
ABS paper screener Att F.2_Paper Screener_CLEAN.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Phase 3 - ABS, paper 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
Form	none	ABS paper screener	Att F.2_Paper Screener_CLEAN.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 56	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	Previously Approved
Annual Number of Responses for this IC	56	42	14
Annual IC Time Burden (Hours)	3	2	1
Annual IC Cost Burden (Dollars)	74	56	18

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.