Information Collection

Screener Verification

IC 216268 under ICR 202211-0920-003 · OMB 0920-0314.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0314 can be found here:

Documents and Forms

Document Name Document Type
ATT-K-NSFG-VerificationProcedures_revMay2021.docx Instruction
ATT-K-NSFG-VerificationProcedures_revMay2021.docx Instruction
ATT_L1_VerificationQues Descrip 040918.doc Verfification Questionnaire Description IC Document
ATT_L1_VerificationQues Descrip 040918.doc Verfification Questionnaire Description IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Screener Verification	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
Instruction			ATT-K-NSFG-VerificationProcedures_revMay2021.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population	FR Citation: 49 FR 37693

Number of Respondents: 1,350	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	1,350	0	1,350
Annual IC Time Burden (Hours)	45	0	45
Annual IC Cost Burden (Dollars)	0	-1,347	1,347

Documents for IC

Title	Document	Date Uploaded
Verfification Questionnaire Description	ATT_L1_VerificationQues Descrip 040918.doc	04/25/2018

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