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Household Survey for General Public_Study Screener
Public Health Systems, Mental Health and Community Recovery Project
OMB: 0920-0993
IC ID: 208429
OMB.report
HHS/CDC
OMB 0920-0993
ICR 201403-0920-001
IC 208429
( )
Documents and Forms
Document Name
Document Type
Household Survey for General Public_Study Screener
Form
Household Screener
Revised Attachment H_ Household Survey for General Public_Study Screener....docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Household Survey for General Public_Study 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
none
Household Screener
Revised Attachment H_ Household Survey for General Public_Study Screener....docx
Yes
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Disaster Management
Subfunction:
Disaster Repair and Restore
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
5,252
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
5,252
0
0
0
0
5,252
Annual IC Time Burden (Hours)
175
0
0
0
0
175
Annual IC Cost Burden (Dollars)
0
0
0
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.