Information Collection

Shedding Questionnaire - Symptomatics

IC 227478 under ICR 201707-0920-005 · OMB 0920-1140.

Documents and Forms

Document Name Document Type
Shedding Questionnaire - Symptomatics Form and Instruction
Baseline and Follow-Up Questionnaire - English Att. H - Baseline and follow-up questionnaire.docx Form and Instruction
Baseline and Follow-Up Questionnaire - Spanish Att. H - Baseline and follow-up questionnaire ESP.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Shedding Questionnaire - Symptomatics	Agency IC Tracking Number:

Is this a Common Form? No		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
Form and Instruction	NA	Baseline and Follow-Up Questionnaire - English	Att. H - Baseline and follow-up questionnaire.docx	NA	No		Paper Only
Form and Instruction	NA	Baseline and Follow-Up Questionnaire - Spanish	Att. H - Baseline and follow-up questionnaire ESP.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: 55	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	440	440
Annual IC Time Burden (Hours)	73	73
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.