View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Questionnaire, web (Att. K-L)	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
Form and Instruction	0920-0822	Att K_Web_Phone Screeners and Survey Instrument_English_REV1.10.23Clean	Att K_Web_Phone Screeners and Survey Instrument_English_REV1.10.23Clean.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0822	Att L_Web_Phone Screeners and Survey Instrument_Spanish	Att L_Web_Phone Screeners and Survey Instrument_Spanish.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

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

Number of Respondents: 26,667	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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	26,667	0	26,472	0	0	195
Annual IC Time Burden (Hours)	11,111	0	11,030	0	0	81
Annual IC Cost Burden (Dollars)	0	0	-2,147	0	0	2,147

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.