Household Roster--Main: Baseline & Follow-up Replenishments

The Real Cost Campaign Outcomes Evaluation Study: Cohort 3 (Outcomes Study)

Documents and Forms

Document Name Document Type
Attachment 1. Parent Guardian Mail Screener.docx Other-ENGLISH Parent Guardian Mail S
Attachment 1. Parent Guardian Mail Screener_rev_SPA_FINAL.docx Other-SPANISH Parent Guardian Mail S

Information Collection (IC) Details

IC Title:	Household Roster--Main: Baseline & Follow-up Replenishments	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
Other-ENGLISH Parent Guardian Mail Screener			Attachment 1. Parent Guardian Mail Screener.docx		No		Paper Only
Other-SPANISH Parent Guardian Mail Screener			Attachment 1. Parent Guardian Mail Screener_rev_SPA_FINAL.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	7,000	1,500	5,500
Annual IC Time Burden (Hours)	560	120	440
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.