Information Collection

Aim 2a Cohort Screener (English/Spanish)

IC 263120 under ICR 202401-0920-004 · OMB 0920-1423.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1423 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form MOD00003217 Aim 2a Cohort Screener (English/Spanish)	Form and Instruction
MOD00003217 Aim 2a Cohort Screener English Att 4f_Aim2aCohortScreenerEnglish CLEAN.docx	Form and Instruction
MOD00003217 Aim 2a Cohort Screener English Att 4f_Aim2aCohortScreenerEnglish CLEAN.docx	Form and Instruction
V2023-1102 Elegibilidad de cohorte (Aim2aCohortScreener_Spanish) Att 4f.a_Aim2aCohortScreenerSpanish CLEAN.docx	Form and Instruction
V2023-1102 Elegibilidad de cohorte (Aim2aCohortScreener_Spanish) Att 4f.a_Aim2aCohortScreenerSpanish CLEAN.docx	Form and Instruction
Att 4f.1_Aim2aCohortScreenerEnglish (TC).docx Att 4f.1_Aim 2a Cohort Screener English	IC Document
Att 4f.1_Aim2aCohortScreenerEnglish (TC).docx Att 4f.1_Aim 2a Cohort Screener English	IC Document

IC Title:

Aim 2a Cohort Screener (English/Spanish)

Agency IC Tracking Number:

0920-1423-24BY

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 and Instruction	MOD00003217	Aim 2a Cohort Screener English	Att 4f_Aim2aCohortScreenerEnglish CLEAN.docx		Yes	Yes	Fillable Fileable
Form and Instruction	V2023-1102	Elegibilidad de cohorte (Aim2aCohortScreener_Spanish)	Att 4f.a_Aim2aCohortScreenerSpanish CLEAN.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 267

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	267	267
Annual IC Time Burden (Hours)	22	22
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 4f.1_Aim 2a Cohort Screener English	Att 4f.1_Aim2aCohortScreenerEnglish (TC).docx	01/05/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.