S4S Screener

“Talk. They Hear You.”: Use of “Screen 4 Success” Instruments and Consent form

OMB: 0930-0390

IC ID: 254542

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

S4S Screener
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction S4S Screener S4S Screener Attachment A S4S Screener.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

S4S Screener  75 FR 28264

100,000 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 100,000 0 100,000 0 0 0
Annual IC Time Burden (Hours) 30,000 0 30,000 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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