Information Collection

After You Deliver

IC 184622 under ICR 200712-0584-003 · OMB 0584-0524.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0524 can be found here:

Documents and Forms

Document Name Document Type
2-19-08ScreeningQuestionnaireEnglish_OMB_-FINAL.pdf Other-Questionnaire
2-19-08ScreeningQuestionnaireSpanish_OMB_-FINAL.pdf Other-Questionnaire Spanish
After You Deliver clearance memo.doc Clearance Memo IC Document
PromotionalFlyer-English.pdf Recruitment Flyer English IC Document
PromotionalFlyer-Spanish.pdf Recruitment Flyer IC Document
After You Deliver ConfidentialityForm.pdf Confidentiality Agreement-English IC Document
After You Deliver ConfidentialityForm-Spanish.pdf Confidentiality Agreement-Spanish IC Document
2-19-08ModeratorGuideEnglish_OMB_-FINAL v2.pdf Moderator Guide English IC Document
2-19-08ModeratorGuideSpanish_OMB_-FINAL v2.pdf Moderator Guide Spanish IC Document
burden table.xls Burden Table IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	After You Deliver	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 246.11

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Questionnaire Spanish			2-19-08ScreeningQuestionnaireSpanish_OMB_-FINAL.pdf		No		Paper Only
Other-Questionnaire			2-19-08ScreeningQuestionnaireEnglish_OMB_-FINAL.pdf		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 225	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 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	225	0	0	0	0	0
Annual IC Time Burden (Hours)	186	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Clearance Memo	After You Deliver clearance memo.doc	04/24/2008
Recruitment Flyer English	PromotionalFlyer-English.pdf	04/24/2008
Recruitment Flyer	PromotionalFlyer-Spanish.pdf	04/24/2008
Confidentiality Agreement-English	After You Deliver ConfidentialityForm.pdf	04/24/2008
Confidentiality Agreement-Spanish	After You Deliver ConfidentialityForm-Spanish.pdf	04/24/2008
Moderator Guide English	2-19-08ModeratorGuideEnglish_OMB_-FINAL v2.pdf	04/24/2008
Moderator Guide Spanish	2-19-08ModeratorGuideSpanish_OMB_-FINAL v2.pdf	04/24/2008
Burden Table	burden table.xls	04/24/2008

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