Information Collection

Peer Recruiters - Recruiter Debriefing Form

IC 234908 under ICR 202202-0920-014 · OMB 0920-1262.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1262 can be found here:

Documents and Forms

Document Name Document Type
Peer Recruiters - Recruiter Debriefing Form Form and Instruction
Recruiter Debriefing Form (English) Att 4c_Recruiter Debriefing Form (English).docx Form and Instruction
Recruiter Debriefing Form (English) Att 4c_Recruiter Debriefing Form (English).docx Form and Instruction
Recruiter Debriefing Form (Spanish) Att 5c_Recruiter Debriefing Form (Spanish).docx Form and Instruction
Recruiter Debriefing Form (Spanish) Att 5c_Recruiter Debriefing Form (Spanish).docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Peer Recruiters - Recruiter Debriefing Form	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 and Instruction	None	Recruiter Debriefing Form (English)	Att 4c_Recruiter Debriefing Form (English).docx		Yes	Yes	Fillable Fileable
Form and Instruction	None	Recruiter Debriefing Form (Spanish)	Att 5c_Recruiter Debriefing Form (Spanish).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 76 FR 4458

Number of Respondents: 1,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,400	500	900
Annual IC Time Burden (Hours)	47	17	30
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.