Information Collection

Parents - ORCHARDS Telephone Screen

IC 212402 under ICR 201710-0920-016 · OMB 0920-1039.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1039 can be found here:

Documents and Forms

Document Name Document Type
Parents - ORCHARDS Telephone Screen Form and Instruction
ORCHARDS Screening Form Att. C2 - Screening Form.docx Form and Instruction
Att D FRN comment.docx Att D - FRN comment IC Document
Att C3- Univ of Wisconsin - consent_assent forms.docx Att C3 Univ of Wisconsin - Consent IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Parents - ORCHARDS Telephone Screen	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 and Instruction	NA	ORCHARDS Screening Form	Att. C2 - Screening Form.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0160 Records of Subjects in Health Promotion and Education Studies, HHS/CDC.CHPE	FR Citation: 51 FR 42484

Number of Respondents: 345	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	345	-5,655	6,000
Annual IC Time Burden (Hours)	29	-471	500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Att D - FRN comment	Att D FRN comment.docx	07/24/2014
Att C3 Univ of Wisconsin - Consent	Att C3- Univ of Wisconsin - consent_assent forms.docx	07/24/2014

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