Information Collection

Recruitment Survey

IC 267992 under ICR 202412-0906-004 · OMB 0906-0100.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Recruitment Survey	Form and Instruction
Form 1 Recruitment Survey Recruitment Survey	Form and Instruction
Form 1_redline Appendix C_Instrument 1 (Updated 12052024) Recruitment Survey	Form and Instruction
1 Recruitment Survey Appendix C Instrument 1 Recruitment Survey (08012024).docx	Form and Instruction
1 Recruitment Survey Appendix C Instrument 1 Recruitment Survey (08012024).docx	Form and Instruction
1_redline Appendix C_Instrument 1 (Updated 12052024) Appendix C Instrument 1 Recruitment Survey 08012024_Approved_updatedBurdenStatement.docx	Form and Instruction
1_redline Appendix C_Instrument 1 (Updated 12052024) Appendix C Instrument 1 Recruitment Survey 08012024_Approved_updatedBurdenStatement.docx	Form and Instruction

IC Title:

Recruitment Survey

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 and Instruction	1				Yes	Yes	Fillable Fileable
Form and Instruction	1_redline				Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

Number of Respondents for Small Entity: 200

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	400	150	250
Annual IC Time Burden (Hours)	24	-19	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.

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