Telephone Screening

Formative Research on Community-Level Factors that Promote the Primary Prevention of Adverse Childhood Experiences (ACEs) and Opioid Misuse Among Children, Youth, and Families in Tribal American India

Documents and Forms

Document Name Document Type
Form 0920-20PJ Telephone Screening Form and Instruction
0920-20PJ Telephone Screening Attachment D_Telephone Screening.docx Form and Instruction
0920-20PJ Telephone Screening Attachment D_Telephone Screening.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Telephone Screening	Agency IC Tracking Number:	0920-20PJ

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 and Instruction	0920-20PJ	Telephone Screening	Attachment D_Telephone Screening.docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 160	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	160	160
Annual IC Time Burden (Hours)	67	67
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.