Information Collection

Individual - Response-Feedback-Request

IC 183165 under ICR 200712-0584-003 · OMB 0584-0524.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0524 can be found here:

Documents and Forms

Document Name Document Type
ATTH 2 User Response Form-Healthy Lifestyle Web Site.doc Other-User Response
ATTH 3 User Response Form-Kids Web Site.doc Other-User Response

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Individual - Response-Feedback-Request	Agency IC Tracking Number:

IC Status: New

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
Other-User Response			ATTH 2 User Response Form-Healthy Lifestyle Web Site.doc		Yes	Yes	Fillable Fileable
Other-User Response			ATTH 3 User Response Form-Kids Web Site.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	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	500	0	0	0	0	0
Annual IC Time Burden (Hours)	83	0	0	0	0	0
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.