Information Collection

Multimedia Screener - Spanish and English

IC 46123 under ICR 200611-0596-002 · OMB 0596-0203.

Documents and Forms

Document Name Document Type
Multimedia Screener - Spanish and English Form
Multimedia Screener - English Appendix A2 - Revised 8-25-06 Multimedia Screener .doc Form
Multimedia Screener - Spanish Appendix A1 - Revised 8-25-06 Multimedia Screener Spanish.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Multimedia Screener - Spanish and English	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Form	None	Multimedia Screener - English	Appendix A2 - Revised 8-25-06 Multimedia Screener .doc		No		Paper Only
Form	None	Multimedia Screener - Spanish	Appendix A1 - Revised 8-25-06 Multimedia Screener Spanish.doc		No		Paper Only

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,400	1,400
Annual IC Time Burden (Hours)	117	117
Annual IC Cost Burden (Dollars)	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.