Information Collection

PART A, ATTACH A_CHP Screener, Baseline, and Topical Questionnaires_v2

IC 260052 under ICR 202305-0607-001 · OMB 0607-1025.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-1025 can be found here:

Documents and Forms

Document Name Document Type
Form PART A, ATTACH A_C PART A, ATTACH A_CHP Screener, Baseline, and Topical Questionnaires_v2 Form
PART A, ATTACH A_C PART A, ATTACH A_CHP Screener, Baseline, and Topical Que PART A, ATTACH A_CHP Screener, Baseline, and Topical Questionnaires_v2 (1).docx Form
PART A, ATTACH A_C PART A, ATTACH A_CHP Screener, Baseline, and Topical Que PART A, ATTACH A_CHP Screener, Baseline, and Topical Questionnaires_v2 (1).docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PART A, ATTACH A_CHP Screener, Baseline, and Topical Questionnaires_v2	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	PART A, ATTACH A_CHP Screener, Baseline, and Topic	PART A, ATTACH A_CHP Screener, Baseline, and Topical Questionnaires_v2 (1).docx	PART A, ATTACH A_CHP Screener, Baseline, and Topical Questionnaires_v2 (1).docx		Yes	Yes	Fillable Fileable

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 217,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	217,500	217,500
Annual IC Time Burden (Hours)	72,428	72,428
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.