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Federal forms, ICRs, and supporting documents

Information Collection

Participant Screener and Recruitment Form

IC 200324 under ICR 201305-0920-007 · OMB 0920-0915.

Documents and Forms
Document Name
Document Type
Other-WORD
IC Document
IC Document
IC Document
Information Collection (IC) Details

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Participant Screener and Recruitment Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Att 5_Screener & Script.docx Yes No Fillable Printable

Health Health Care Services

 

120 0
   
Individuals or Households
 
   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 120 0 120 0 0 0
Annual IC Time Burden (Hours) 24 0 24 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SUPPLEMENTAL1_Permission Form for Parents of Adolescents Ages 15-17 (100511 (2) SUPPLEMENTAL1_Permission Form for Parents of Adolescents Ages 15-17 (100511 (2).docx 05/10/2013
SUPPLEMENTAL2_Assent for Adolescents Aged 15-17 (100511) (2) SUPPLEMENTAL2_Assent for Adolescents Aged 15-17 (100511) (2).docx 05/10/2013
SUPPLEMENTAL3_ Informed Consent for Adults (100511) (2) SUPPLEMENTAL3_ Informed Consent for Adults (100511) (2).docx 05/10/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.