Information Collection

Landline Screener - Child

IC 224741 under ICR 202306-0920-014 · OMB 0920-1204.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Landline Screener - Child	Form
Landline Screener - Child Att5c ACBS Lndn Scrnr Child 2023 Rev06262023_OS.docx	Form
Landline Screener - Child Att5c ACBS Lndn Scrnr Child 2023 Rev06262023_OS.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	Landline Screener - Child	Att5c ACBS Lndn Scrnr Child 2023 Rev06262023_OS.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 834

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	834	-1,742	2,576
Annual IC Time Burden (Hours)	28	-15	43
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.