Information Collection

Cellphone Screener - Child

IC 224742 under ICR 202306-0920-014 · OMB 0920-1204.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Cellphone Screener - Child	Form
Cell Phone Screener - Child Att5d ACBS Cllphn Scrnr Child 2023 Rev06262023_OS.docx	Form
Cell Phone Screener - Child Att5d ACBS Cllphn 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	Cell Phone Screener - Child	Att5d ACBS Cllphn 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: 4,109

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	4,109	285	3,824
Annual IC Time Burden (Hours)	137	73	64
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.