Telephone Screener

Resource for the Collection and Evaluation of Human Tissues and Cells from Donors with an Epidemiology Profile (NCI)

Documents and Forms

Document Name Document Type
Form 1 Telephone Screener Form
1 Telephone Screener Attach 16 - REVISED - Telephone Screener.doc Form
Attach 22 - REVISED_Telephone Interview Script_11-10-2010.doc Telephone Script IC Document

Information Collection (IC) Details

IC Title:	Telephone Screener	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	1	Telephone Screener	Attach 16 - REVISED - Telephone Screener.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Clinical, Basic and Population-based Research Studies of the National Institutes of Health (NIH), HHS/NIH/OD	FR Citation: 67 FR 60776

Number of Respondents: 1,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,700	1,700
Annual IC Time Burden (Hours)	283	283
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Telephone Script	Attach 22 - REVISED_Telephone Interview Script_11-10-2010.doc	11/20/2010

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