Information Collection

Cell Phone Screener - Adult

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Cell Phone Screener - Adult	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
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 %

	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

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.