Information Collection

Human Behavior in Fire Studay - Adults Case and Controls - CAPI questionaire

IC 45667 under ICR 200610-0920-004 · OMB 0920-0734.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form None assigned Human Behavior in Fire Studay - Adults Case and Controls - CAPI questionaire	Form and Instruction
None assigned Appendix 3_CAPI Appendix 3_CAPI.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None assigned	Appendix 3_CAPI	Appendix 3_CAPI.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 59 FR 67080

Number of Respondents: 434

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	434	434
Annual IC Time Burden (Hours)	434	434
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.