Information Collection

Screening Verification

IC 195361 under ICR 202501-0930-001 · OMB 0930-0110.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0110 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2025 CATI Verifica Screening Verification	Form and Instruction
Form 2025 CATI Verifica 2025 CATI Verification Scripts Screening Verification	Form and Instruction
2025 CATI Verifica 2025 CATI Verification Scripts Attachment V_CATI Verification Scripts_2025_Final 9-30-24.pdf	Form and Instruction
2025 CATI Verifica 2025 CATI Verification Scripts Attachment V_CATI Verification Scripts_2025_Final 9-30-24.pdf	Form and Instruction

IC Title:

Screening Verification

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	2025 CATI Verification Scripts				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Alcohol, Drug Abuse, and Mental Health Epidemiologic Data (HHS/SAMHSA/OA)

FR Citation: 84 FR 27341

Number of Respondents: 6,004

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	6,004	6,004
Annual IC Time Burden (Hours)	402	402
Annual IC Cost Burden (Dollars)	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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