View Information Collection (IC)

View Information Collection (IC)

IC Title:	Asthma Management Supplement	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
Form	none	2012 Asthma Supplement	0920-0222 QDRL Asthma Attach 1.pdf		Yes	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population	FR Citation: 49 FR 37693

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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	40	0	0	0	0	0
Annual IC Time Burden (Hours)	40	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Flyer	0920-0222 QDRL Asthma Attach 2.docx	08/03/2011
Invitation Letter	0920-0222 QDRL Asthma Attach 3.docx	08/03/2011
Supporting 10-Day Letter	0920-0222 QDRL Asthma 10-day letter.doc	08/04/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.