Att H1_Eligibility Screening

A Longitudinal Examination of Mental and Physical Health among Police Associated with COVID–19

Documents and Forms

Document Name Document Type
Form 0920- Att H1_Eligibility Screening Form
0920- Eligibility Screening Appendix H1_Eligibility Screening.docx Form
0920- Eligibility Screening Appendix H1_Eligibility Screening.docx Form

Information Collection (IC) Details

IC Title:	Att H1_Eligibility Screening	Agency IC Tracking Number:	0920-21CG

Is this a Common Form? No		IC Status: Unchanged

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-	Eligibility Screening	Appendix H1_Eligibility Screening.docx		No		Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	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	200	200
Annual IC Time Burden (Hours)	17	17
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.