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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Human Behavior in Fire Studay - Adults Case and Controls - CAPI questionaire	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
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 %

	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

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.