Information Collection

Att M_CDC Water and Health Study (Web-Based Questionnaire)

IC 204801 under ICR 201409-0920-014 · OMB 0920-0960.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0960 can be found here:

Documents and Forms

Document Name Document Type
M.Survey (revised) Screen Shots.pdf Other-Screen shots

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Att M_CDC Water and Health Study (Web-Based Questionnaire)	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
Other-Screen shots			M.Survey (revised) Screen Shots.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 252

Number of Respondents: 810	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	810	-519	1,329
Annual IC Time Burden (Hours)	162	-104	266
Annual IC Cost Burden (Dollars)	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.