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Evaluation of Efficacy of Household Water Filtration/Treatment Devices in Households with Private Wells - Screening Questionnaire

IC 7138 under ICR 200612-0920-011 · OMB 0920-0670.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Evaluation of Efficacy of Household Water Filtration/Treatment Devices in Households with Private Wells - Screening Questionnaire
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None assigned Attach 4_Participant Screening Questionnaire 0920-0670 attachments (11-29-2006) final.doc Yes Yes Printable Only

Health Public Health Monitoring

 

1,200 0
   
Individuals or Households
 
   0 %

  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 1,200 0 -600 0 0 1,800
Annual IC Time Burden (Hours) 100 0 -200 0 0 300
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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