View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Augmentation Screener
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Augmentation Screener Questionnaire Augmentation Screener Questionnaire Attachment G. Augmentation Screener Questionnaire final.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

1,300 0
   
State, Local, and Tribal Governments
 
   100 %

  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 1,300 0 0 0 0 1,300
Annual IC Time Burden (Hours) 104 0 0 0 0 104
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Augmentation Screener Questionnaire - Track Attachment G1. Augmentation Screener Questionnaire - Track Changes final.docx 11/30/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.