Information Collection

Cell Phone Screener - Adult

IC 224740 under ICR 202306-0920-014 · OMB 0920-1204.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Cell Phone Screener - Adult	Form
Cell Phone Screener - Adult Att5b ACBS CllPh Scrnr Adult 2023 Rev.docx	Form
Cell Phone Screener - Adult Att5b ACBS CllPh Scrnr Adult 2023 Rev.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	None	Cell Phone Screener - Adult	Att5b ACBS CllPh Scrnr Adult 2023 Rev.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,780

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	20,780	4,047	16,733
Annual IC Time Burden (Hours)	346	67	279
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.