View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Att 1db_Model Patient Recruitment Script-Tex and E-mail	Agency IC Tracking Number:	0920-0222

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
Instruction					No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,760	Number of Respondents for Small Entity: 936

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

	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	7,760	0	-960	0	0	8,720
Annual IC Time Burden (Hours)	388	0	-48	0	0	436
Annual IC Cost Burden (Dollars)	9,677	0	-1,197	0	0	10,874

Documents for IC

Title	Document	Date Uploaded
11a_Model Patient Recruitment Letter		05/17/2018

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

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