View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Long COVID Surveys	Agency IC Tracking Number:	Long COVID Surveys 2900-0876

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	Long Covid Survey Wires 2023_02_10	Long Covid Survey Wires 2023_02_10	Long Covid Survey Wires 2023_02_10.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 22,041	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	22,041	0	22,041	0	0	0
Annual IC Time Burden (Hours)	1,837	0	1,837	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
A-11 Fast-Track Clearance Request Template_Long COVID	A-11 Fast-Track Clearance Request Template_Long COVID.pdf	02/15/2023

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