Information Collection

Introductory Survey

IC 220785 under ICR 201604-0920-004 · OMB 0920-1109.

Documents and Forms

Document Name Document Type
Introductory Survey Form and Instruction
Verbal Script for Consent and Introductory Survey Att. C -- Verbal Script for Consent and Introductory Survey.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Introductory Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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
Form and Instruction	NA	Verbal Script for Consent and Introductory Survey	Att. C -- Verbal Script for Consent and Introductory Survey.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	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.