Information Collection

Model Patient Recruitment Script - Facility

IC 180566 under ICR 202402-0920-006 · OMB 0920-0740.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0740 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Model Patient Recruitment Script - Facility	Form and Instruction
Recruitment script Att 8c Recruitment Script Facility.docx	Form and Instruction
Recruitment script Att 8c Recruitment Script Facility.docx	Form and Instruction

IC Title:

Model Patient Recruitment Script - Facility

Agency IC Tracking Number:

0920-0740

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	none	Recruitment script	Att 8c Recruitment Script Facility.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 970

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	Previously Approved
Annual Number of Responses for this IC	970	970
Annual IC Time Burden (Hours)	81	81
Annual IC Cost Burden (Dollars)	2,027	2,027

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.