View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Enrollment Packet (DD)	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
Other-WORD			Attachment 11.b. Overall Consent _DD SEED 3_revised.doc		No		Fillable Fileable
Other-WORD			Attachment 21.b. Invitation Call Script - DD source selection SEED 3_revised.docx		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 175	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	175	0	175	0	0	0
Annual IC Time Burden (Hours)	58	0	58	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Att 18_ Study Flow Chart for Participant	Attachment 18. Participant Flow Chart_revised.docx	10/27/2016
Att 20b_Enrollment Packet Cover Letter DD	Att 20.b. Enrollment Packet Cover Letter DD SEED 3_3-7-17.docx	03/16/2017

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