Information Collection

Att 1db_Model Patient Recruitment Script-Tex and E-mail

IC 180566 under ICR 201805-0920-003 · OMB 0920-0740.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0740 can be found here:

Documents and Forms

Document Name Document Type
Att 11d_MMP Recruitment Text E-mail.docx Instruction
Att 11a_Model recruitment letter.docx 11a_Model Patient Recruitment Letter IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Att 1db_Model Patient Recruitment Script-Tex and E-mail	Agency IC Tracking Number:	0920-0222

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
Instruction			Att 11d_MMP Recruitment Text E-mail.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,760	Number of Respondents for Small Entity: 936

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	7,760	-960	8,720
Annual IC Time Burden (Hours)	388	-48	436
Annual IC Cost Burden (Dollars)	9,677	-1,197	10,874

Documents for IC

Title	Document	Date Uploaded
11a_Model Patient Recruitment Letter	Att 11a_Model recruitment letter.docx	05/17/2018

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