OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Screening and Consent

IC 200737 under ICR 201411-0920-011 · OMB 0920-0923.

Documents and Forms
Document Name
Document Type
Form
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Screening and Consent
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Screening Questionnaire - Spanish Screenshots Attachment C-1 (Screenshots Spanish) 2-6-14.pdf Yes Yes Fillable Fileable
Form none Screening Questionnaire - screenshots Attachment C-1 (Screenshots) 2-6-14.pdf Yes Yes Fillable Fileable

Health Immunization Management

 

13,074 0
   
Individuals or Households
 
   100 %

  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 13,074 0 0 0 0 13,074
Annual IC Time Burden (Hours) 1,090 0 0 0 0 1,090
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Screening Questionnaire - Spanish Attachment C-1 (Spanish) 2-6-14.doc 02/10/2014
Screening Questionnaire - Word Attachment C-1 Screening Questionnaire 2-6-14 (FINAL).docx 02/10/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.