Information Collection

Sample Screener

IC 43990 under ICR 200708-1850-006 · OMB 1850-0805.

Documents and Forms

Document Name Document Type
Screener_SAQ_Child_rev.pdf Other-child screener
Screener_SAQ_Twins_rev.pdf Other-twin screener

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Sample Screener	Agency IC Tracking Number:	3385

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-child screener			Screener_SAQ_Child_rev.pdf		No		Paper Only
Other-twin screener			Screener_SAQ_Twins_rev.pdf		No		Paper Only

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,722	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 30 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,722	-20,536	25,258
Annual IC Time Burden (Hours)	378	-13,392	13,770
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.