Information Collection

Landline Screener - Adult

IC 224739 under ICR 202306-0920-014 · OMB 0920-1204.

Documents and Forms

Document Name Document Type
Landline Screener - Adult Form
Landline Screener - Adult Att5a ACBS Lndln Scrnr Adult 2023 Rev.docx Form
Landline Screener - Adult Att5a ACBS Lndln Scrnr Adult 2023 Rev.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Landline Screener - Adult	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	None	Landline Screener - Adult	Att5a ACBS Lndln Scrnr Adult 2023 Rev.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,170	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	8,170	-9,630	17,800
Annual IC Time Burden (Hours)	136	-161	297
Annual IC Cost Burden (Dollars)	0	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.