Information Collection

Eligibility Script for Pretest

IC 181528 under ICR 201003-0920-008 · OMB 0920-0761.

Documents and Forms

Document Name Document Type
Form no number Eligibility Script for Pretest Form
no number Eligibility Script ATTACHMENT I - Eligibility script.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Eligibility Script for Pretest	Agency IC Tracking Number:

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
Form	no number	Eligibility Script	ATTACHMENT I - Eligibility script.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 70	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	Previously Approved
Annual Number of Responses for this IC	70	-1,533	1,603
Annual IC Time Burden (Hours)	1	-26	27
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.