View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Symptom survey	Agency IC Tracking Number:	0920-1316

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	0920-1316				Yes	Yes	Fillable Fileable
Form	0920-1316			NA	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: Epidemiologic studies and surveillance of disease problems.	FR Citation: 57 FR 62812

Number of Respondents: 67	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	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	670	0	0	0	0	670
Annual IC Time Burden (Hours)	168	0	0	0	0	168
Annual IC Cost Burden (Dollars)	0	0	-4,087	0	0	4,087

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.

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