OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Screener (Att. K-N )

IC 239167 under ICR 202503-0920-002 · OMB 0920-0822.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Screener (Att. K-N )
 
Yes Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0822 Att K_Web_Phone Screeners and Survey Instrument_English Att K_Web_Phone Screeners and Survey Instrument_English_REV1.10.23Clean.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0822 Att N_Paper Screener_Spanish Att N_Paper Screener_Spanish.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

Epidemiologic Studies and Surveillance of Disease Problems  57 FR 62812

48,667 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 48,667 0 0 0 0 48,667
Annual IC Time Burden (Hours) 4,056 0 0 0 0 4,056
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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