Information Collection

Screener Survey

IC 183318 under ICR 200712-1625-005 · OMB 1625-0089.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1625-0089 can be found here:

Documents and Forms

Document Name Document Type
1625-0089 SCREENER Survey-Registration Data (3).pdf Survey. Not available online. Other-Screener Survey
1625-0089 SCREENER Survey-No Registration Data (3).pdf Survey. Not available online. Other-Screener Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Screener Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 46 CFR 13101

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screener Survey			1625-0089 SCREENER Survey-Registration Data (3).pdf	Survey. Not available online.	Yes	Yes	Fillable Printable
Other-Screener Survey			1625-0089 SCREENER Survey-No Registration Data (3).pdf	Survey. Not available online.	Yes	Yes	Fillable Printable

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 571,429	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	571,429	571,429
Annual IC Time Burden (Hours)	47,619	47,619
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.