Information Collection

Model Patient Recruitment Script - Facility

IC 180566 under ICR 202503-0920-027 · OMB 0920-0740.

Documents and Forms

Document Name Document Type
Model Patient Recruitment Script - Facility Form and Instruction
Model Patient Recruitment Script - Facility Form and Instruction
Recruitment script Att 8c Recruitment Script Facility.docx Form and Instruction
Recruitment script Att 8c Recruitment Script Facility.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Model Patient Recruitment Script - Facility	Agency IC Tracking Number:	0920-0740

Is this a Common Form? No		IC Status: Unchanged

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	none	Recruitment script	Att 8c Recruitment Script Facility.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 970	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	970	970
Annual IC Time Burden (Hours)	81	81
Annual IC Cost Burden (Dollars)	2,027	2,027

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.