Information Collection

Att 4a_Screening Call Script_Part A (all respondents)

IC 179024 under ICR 202108-0920-021 · OMB 0920-0743.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0743 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0743 Att 4a_Screening Call Script_Part A (all respondents) Form
0920-0743 Screening Telephone Call to Identify the Appropriate Sur Attachment 4a Screening Call Script_Part A.docx Form
0920-0743 Screening Telephone Call to Identify the Appropriate Sur Attachment 4a Screening Call Script_Part A.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Att 4a_Screening Call Script_Part A (all respondents)	Agency IC Tracking Number:	0920-0743

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	0920-0743	Screening Telephone Call to Identify the Appropriate Survey Contact Person at Eligible Facilities	Attachment 4a Screening Call Script_Part A.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,101	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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,101	149	1,952
Annual IC Time Burden (Hours)	35	2	33
Annual IC Cost Burden (Dollars)	0	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.